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What is SPECT imaging and how does it work?

Posted on: 03.07.19

SPECT stands for single-photon emission computerized tomography. In layman’s terms, it’s a type of non-invasive nuclear imaging test that allows your doctor to see how well your internal organs are functioning. It uses a radioactive substance and a special gamma camera to create 3-D pictures of your organs at different angles.

Gamma cameras like the Digirad Cardius® 3 XPO and the X-ACT+ employ advanced solid-state technology that uses a silicon-based photodiode, coupled with cesium iodide (CsI). The technology not only offers better sensitivity and high energy resolution, but it also makes the camera smaller in size than a traditional MRI machine. And, with their open and upright design, they’re much more ergonomic and patient-friendly.

While an x-ray takes a picture of what your organs look like at a given point in time, a SPECT image shows blood flowing to and from the heart or blood flow restrictions due to narrow or blocked arteries. It can also be used to evaluate brain and neurological conditions and bone disorders.

In what cases is SPECT imaging ordered?

Not only can SPECT imaging capture how well your heart is performing, but it can also help diagnose disease processes that may be underway, including narrowing of the arteries, clogged arteries, identifying scar tissue due to heart attacks, or evaluating the success of surgeries like bypass surgery.

How does SPECT imaging work?

SPECT scans use a radioactive material called a tracer. The tracer is injected intravenously and mixes with your blood. As your blood moves through your body, it’s “taken up” or absorbed by your living heart muscle.

The Digirad Cardius® 3 XPO and the X-ACT+ allow for patients to be imaged in a comfortable seated position but other gamma cameras require you to lie down on a table. During the scan, the SPECT camera rotates around you. It picks up signals from the radioactive tracer, which are then converted to 3-D images by a computer.

When you undergo a nuclear stress test, a SPECT scan will be taken while you’re exercising and again when you’re at rest. The comparison of the images will allow your physician to evaluate blood flow under different levels of exertion.

Your images may show different shades of color that will indicate which areas of your heart absorbed more of the radioactive tracer and which areas absorbed less. A normal test result indicates there is sufficient and unrestricted blood flow to your heart, while an abnormal result means your heart’s blood flow is insufficient. Once your physician reviews your images, you’ll meet to discuss the results and any necessary treatment plan.

Example of SPECT imaging heart scan

What are the risks of SPECT imaging?

SPECT imaging is generally safe and most patients can go back to their normal activity right away. The amount of radioactive material injected into your bloodstream is small and your body will expel it through your kidneys in 24 to 72 hours. Be sure to drink plenty of water for a few days following the procedure.

If you are pregnant, think you may be pregnant, or are a nursing mother, be sure to notify your doctor prior to the scan. The test uses a low-dose of radiation, which is contraindicated for pregnant women. Nursing mothers may be advised to wait additional time before nursing again so that your body can excrete the tracer.

Patients may also have an allergic reaction to the radioactive tracer, although it’s uncommon.

SPECT imaging is a popular, cost-effective, and safe method of evaluating your heart and diagnosing disease. While you may be a little anxious, be assured that the scan is painless and it provides important clinical value to your physician.

Healthcare QuickLinks: The case for decentralization of health care, radiopharma user rules, and more

Posted on: 02.21.19

Healthcare is ever changing, so it’s important to stay up to date on advancements and issues that may impact the development, operation, maintenance, and growth of your services. Here are some important developments:

Do hospitals still make sense? The case for decentralization of health care

From their humble origins as charitable almshouses for the poor and destitute who could not afford to receive care at home, hospitals have evolved into large, profitable, expensive, technology-laden institutions at the epicenter of the health care universe. Almost every community has at least one general centralized hospital, and most have more than one — with those that don’t being considered “underserved” or “frontier” communities, and with the hospitals in such communities sometimes receiving the designation of “critical access.” But health care is changing and until recently, centralizing care around a hospital made sense. Continue reading…

Las Vegas brain institute takes on unique Alzheimer’s, Parkinson’s project

In the only trial of its kind in the United States, a Las Vegas doctor is injecting patients with a radioactive liquid and scanning their brains in hopes of discovering the cause of Alzheimer’s and Parkinson’s diseases. Dr. Aaron Ritter at the Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas received approval from the Food and Drug Administration to test the GE180 tracer in humans to research neurodegeneration. Continue reading…

SNMMI, ACNM oppose relaxing radiopharma user rules

The Society of Nuclear Medicine and Molecular Imaging (SNMMI) and the American College of Nuclear Medicine (ACNM) have submitted a joint statement opposing any changes in the U.S. Nuclear Regulatory Commission’s (NRC) training and experience requirements for healthcare personnel to administer radiopharmaceuticals. The NRC is pondering the creation of a “limited user” category for physicians with little or no background in nuclear medicine. While no formal framework is in place, it is anticipated that the training and experience requirements to become a limited user would be much less rigorous than the current standards for authorized users and other nuclear medicine practitioners. Continue reading…

Prior authorizations still a pain for patients, practices, survey finds

Insurance prior authorizations for certain drugs, tests and treatments continue to burden medical practices and could negatively affect patient outcomes, according to new survey results from the American Medical Association.The survey took place in December, 2018 among 1,000 practicing physicians. Here are the top seven findings. Continue reading…

18Fluorocholine-PET/CT demonstrates better clinical utility than conventional prostate imaging

First-line imaging with ¹⁸fluorocholine-PET/CT demonstrated more clinical utility than conventional imaging for identifying prostate lesions with a high impact on patient management, according to results of a randomized trial presented at Genitourinary Cancers Symposium. However, researchers did not observe an increase in prognostic performance with the different imaging modality, and both approaches appeared to have a poor negative predictive value. Continue reading…

What’s next for SPECT with Kathy Flood

Posted on: 02.14.19

After several years of reduced reimbursements and decreasing volumes, SPECT imaging has stabilized and is primed for growth. Digirad recently spoke with Kathy Flood, CEO of the American Society of Nuclear Cardiology, to get her viewpoint on SPECT imaging and where the modality is headed.

“Volumes are not dropping as dramatically as they were in the past,” she said, “one factor in this is that people are recognizing the value of nuclear cardiology, and secondly we’re seeing increases due to the implementation of appropriate use criteria.” ASNC has supported their members with increased education on appropriate use, which is helping. But, looking down the road, the applications for SPECT nuclear are beginning to grow.

SPECT Applications for Cardiac Amyloidosis

One of those new applications involves cardiac amyloidosis. In the past, a cardiac amyloidosis diagnosis could only be confirmed with a cardiac biopsy. And still, there was no available treatment. Now, a nuclear scan using technetium-99m pyrophosphate (Tc 99m PYP) is almost as effective as a cardiac biopsy.

With treatment drugs in the pipeline, there’s an exciting opportunity for nuclear imaging to play a significant role in both the diagnosis and management of the disease.

The availability of new treatments has heightened the importance of awareness, early diagnosis, and accurate typing of cardiac amyloidosis. In response, ASNC is working on an educational campaign that focuses on PYP imaging for patients with suspected cardiac amyloidosis.

New Educational Initiatives

ASNC’s annual Nuclear Cardiology Today Event, scheduled for April 12-14, 2019, will include a practical workshop on cardiac amyloidosis where not only nuclear cardiologists, but also referring physicians can learn about the disease.

The half-day, case-based program will address the diagnosis and management, tackle the challenges of disease presentation, discuss the role of various imaging modalities in the diagnosis, and give an overview of current and emerging treatments.

Cardiac amyloidosis is considered a rare and potentially under-diagnosed disease. One of the contributing factors is that its symptoms closely resemble heart failure. As statistics say that about 30% of heart failure patients have been misdiagnosed and that heart failure is the number one disease state where Medicare spends money, that equates to a lot of patients.

“Our goal is to make our members and referring physicians aware of cardiac amyloidosis, about the role of nuclear cardiology, and how to provide high-quality imaging around that for decision making and treatment,” said Flood.

ASNC also plans to offer more hands-on simulation opportunities at their meetings so that members can network with experts in their field, better understand how they’re performing nuclear cardiology, and learn how they can improve. Taking those experiences back to their labs will help them provide the best images for their patients.

Investing in the Next Generation

Looking ahead, ASNC is intent on making sure their members have what they need, but they’re also making investments in the new generation. “We’re working to put together programs specifically for the cardiology fellowship training programs. We want to be able to either help supplement some of the nuclear education they receive, or if they don’t receive any, be able to direct them to ASNC,” said Flood.

SPECT remains the most common procedure in nuclear cardiology, but the younger generation tends to focus on the newer modalities, like Cardiac CT. Once they graduate, they’re often unable to use this knowledge in practice because the new modalities are not as widespread in the field. That’s when they look back and wish they would have spent more time on SPECT imaging.

“We’re trying to fill that void as we move forward over the next couple of years so we have more programs and touch points with fellows in training so they can get just as excited about nuclear, too,” said Flood.

UPMC Launches First Mobile Xe-133 Lung Ventilation Scan System in the United States

Posted on: 01.24.19

In a recent issue of Pediatric Insights, Michael R. Czachowski, MBA, CNMT, NCT, PET, ASCP(N), R.T.(N)(BD) (ARRT), discussed the idea and the execution of the first portable Xenon-133 lung ventilation exam performed in the United States on a patient in a pediatric cardiac intensive care unit.

Czachowski is the supervisor of the Nuclear Medicine and Molecular Imaging Departments at UPMC Children’s Hospital, where the groundbreaking procedure was performed. The process, which was implemented to allow technicians to perform portable ventilation lung exams in the CICU and to alleviate the need to move medically fragile patients to the nuclear medicine department, was made possible with the use of the Digirad Ergo™ portable nuclear camera.

Ventilation lung exams the CICU were previously prohibited because of the inability to safely deliver the Tc-99m DTPA (diethylenetriamine pentaacetic acid) aerosol and the risk of radiation contamination.

Collaboration overcomes obstacles

During a previous portable perfusion lung exam in the CICU, Czachowski’s team was questioned about the possibility of performing a portable ventilation lung exam. The challenge sparked some thought–and a lot of innovation among his team. Through much discussion, brainstorming, option searching, and evaluation, Czachowski and his collaborators agreed that the use of Xenon-133 gas in conjunction with the patient’s ventilator and the Pulmonex system was the most highly viable solution.

The Pulmonex system, which when used in the nuclear medicine department, safely captures exhaled radioactive Xenon-133 through a lead-lined trap. The hurdle was finding a way to capture the gas from the patient, contain it, and maintain the patient’s ventilator dependency, all while remaining in the CICU.

Leveraging the expertise of Alvin Saville, RRT, Respiratory Education Coordinator at UPMC Children’s Hospital, a tubing adaptor placed between the patient’s ventilator circuit and the endotracheal tube was added. It successfully trapped the patient’s exhaled radioactive Xenon-133 inside the Pulmonex system, which ensured a safe environment for the patient, staff, and family.

Innovation pays off in the CICU

In April 2018, after months of development and testing, the successfully modified system was used for the first time on a patient in the CICU. Although they continue to refine the protocol, “to do the lung ventilation exam with no interruption of the patient’s physiological and physical environment in the CICU or elsewhere is quite an accomplishment,” said Czachowski. It has created a seamless process that is both safe and efficient.

You can find the original announcement about the First Mobile Xe-133 Lung Ventilation Scan System in the United States here.

Healthcare QuickLinks: New SPECT guidelines, radiopharmaceutical tracers for cardiac imaging, and more

Posted on: 01.17.19

Researchers identify features least-sensitive to PET system variations

Researchers from the Medical University of Vienna in Austria provided new guidance for selecting optimizing features from 18F-FDG-PET/CT studies—demonstrating feature variations can be minimized for selected image parameters and imaging systems, in a new study published in the Journal of Nuclear Medicine. Laszlo Papp, PhD, and colleagues imaged a whole-body phantom with 13 PET/CT systems at 12 different sites. Continue reading…

Single photon emission computed tomography (SPECT) myocardial perfusion imaging guidelines: Instrumentation, acquisition, processing, and interpretation.

Recent advances in Single Photon Emission Computed Tomography (SPECT) have fundamentally changed acquisition, processing, and interpretation of myocardial perfusion images. Myocardial perfusion imaging (MPI) can now be personalized and tailored to the individual patient and the clinical question. Review the most up to date MPI guidelines for conventional and novel SPECT for qualified medical professionals engaged in the practice of nuclear cardiology. Continue reading…

Radiopharmaceutical tracers for cardiac imaging

Cardiovascular disease (CVD) is the leading cause of death and disease burden worldwide. Nuclear myocardial perfusion imaging with either single-photon emission computed tomography or positron emission tomography has been used extensively to perform diagnosis, monitor therapies, and predict cardiovascular events. Several radiopharmaceutical tracers have recently been developed to evaluate CVD by targeting myocardial perfusion, metabolism, innervation, and inflammation. Continue reading…

Blue House, Red Senate: What Now For American Healthcare?

The 2018 midterms left the Republicans with the Senate majority and the Democrats with control of the House. The congressional split bodes poorly for the 71% of voters who labeled healthcare as “very important” in determining their vote. In this article, would-be voters were asked to get specific about which healthcare issues matter to them most. See the top six issues and how likely they are to be addressed by Congress in the next two years. Continue reading…

Type 2 Diabetes an independent risk factor for coronary artery disease

According to study results published in Heart Rhythm Society, type 2 diabetes is an independent risk factor for sudden cardiac arrest and death in patients with coronary artery disease with preserved ejection fraction. With this prospective observational study, researchers sought to compare the incidence of sudden cardiac death in Finnish patients with and without T2D who had CAD and preserved ejection fraction. Continue reading…

How to set up shop as an independent MD

Physicians everywhere are realizing the benefits of breaking free from the drudgery of full-time employment with a large healthcare corporation. As the healthcare pendulum has swung away from private practice to employed physicians—the desire has escalated to return some autonomy back to those once independent doctors. There’s a huge supply-demand mismatch that is working in physicians’ favor and if they’re savvy about it, they’ll consider the options they have at their disposal to help them move away from full-time clinical work. Continue reading…

4 ways to prepare for MACRA in 2019

The new year is here, and practices must keep pace with evolving Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) policies. With the new final reporting rule, it’s often difficult to balance optimizing the revenue cycle while monitoring impacts on performance scores and operational workflows. To combat these challenges, practices can apply four tips to enhance cash flow while being mindful of MACRA’s Merit-based Incentive Payment System (MIPS) reporting requirements. Continue reading…

3 Critical Timing and Inventory Considerations for Interim Imaging

Posted on: 01.10.19

Interim imaging can be the answer to many of the challenges providers and hospitals face when it comes to managing their imaging needs. Successful execution of a short-term solution, however, begins in the planning stage. Here are some things you’ll need to consider:

1. Timing Requirements for Interim Imaging

Preparing for the transition to interim imaging should start well in advance of the date in which it’s needed. In fact, contact with the rental provider should be initiated as soon as the decision is made to move forward with renovations or new imaging equipment.

Although a four-month lead-time is ideal, it is possible to obtain mobile interim imaging equipment within a shorter time frame. During the time before the delivery of the asset, you’ll work with a vendor to determine your equipment needs, iron out the logistics, negotiate a contract, schedule any necessary training, and coordinate delivery options.

Of course, the terms of the rental contract are a critical piece of the process, but special consideration should be given to the beginning and end dates.

Consider allowing a short period of overlap at the beginning of the contract, which provides your staff ample time to transition to the equipment and workflow. Make sure to give yourself a little extra time at the tail end of the contract to help alleviate any potential disruptions caused by unforeseen delays in the project.

Keep in mind, these interim imaging units are often reserved far in advance by hospitals and imaging facilities throughout North America. While most imaging providers are willing to be flexible and extend an existing contract, it may not always be an option due to other commitments.

Communication with your mobile imaging provider is essential. This will help ensure an all-around successful project outcome, especially if the completion timeline begins to push out to a later date. It is important to notify your imaging provider ASAP when a project may need to extend. The earlier the notification is provided, the higher the likelihood the equipment will be available to accommodate the extension.

2. Locating Interim Imaging Equipment

Most interim imaging systems are rented on a first come, first served basis and there is a limited supply. The earlier you initiate contact with a rental provider and determine your equipment needs, the higher the likelihood of securing the equipment you requested. Don’t wait until the last minute and find you have no option but to settle for the equipment the provider has in inventory, or worse yet, push out your project timeline.

Ideally, your interim rental equipment should be the same as, or as close as possible, to your current system; age, make, model, software level, etc. In which case, your staff will require less training, experience minimal disruption in service, and allow for a shorter and smoother transition period.

For those reasons, the more advanced notice a provider has to identify, locate, and reserve equipment, the better the chances of finding the best fit.

3. Interim Imaging Workflow Considerations

Imaging equipment that is different from your current system might require changes in protocols. Matching the manufacturer, type of software, and available options can be more difficult for some modalities than others. The good news is that some interim imaging providers can offer applications support if needed.

Each modality has its own set of considerations. For example, with MRI, there is the need to identify and best match or locate specific coils that are needed to perform certain exams. These seemingly small details could significantly affect the supplier’s ability to locate the “best fit” due to limited industry supply or other factors, and therefore must be addressed in advance.

All projects come with their own set of hurdles. With interim imaging, many of those challenges can be avoided or minimized by reaching out to your rental provider as early as possible and clearly communicating your needs throughout the entire project. You’ll benefit from a higher quality of service, a smoother transition, and an overall better experience.

Where does Cardiac PET fit in your current imaging offerings?

Posted on: 12.20.18

Offering in-house Cardiac PET imaging to your patients adds a new modality to your imaging toolbox. This modality can expand your services by offering another option for diagnostic imaging while potentially providing an additional revenue stream.

If you’re thinking of adding Cardiac PET, it’s important to consider how the new modality will fit with your current imaging offerings. Think about how it could affect the level of service you provide and what its impact might be on your bottom line. Let’s take a look at where Cardiac PET fits in your current imaging offerings:

Top-Level and Bottom-Line Considerations

The addition of Cardiac PET imaging may not provide a clear net gain for your facility. Most practices will end up replacing some of their current SPECT imaging volume with PET because it may be a more appropriate choice. With the addition of PET, you can expect the volume to decline in one modality and rise in the other, at least in the short term.

If your practice is currently overbooked or your staff is overworked, Cardiac PET could offer relief and if your monthly volumes are sustainably high enough, this modality may positively affect your bottom line. However, if your current imaging is underutilized, it could worsen your situation.

As you make your decision, you’ll need to account for the new capabilities that Cardiac PET can offer. Think through when and why you would offer PET vs. SPECT and the additional flexibility it can provide you with patient care. You must also fully understand the reimbursement criteria of all of your payers and plans.

Establishing clear guidelines prior to the arrival of the camera is the best way to eliminate confusion. It will also help you utilize the imager in the most effective and efficient manner.

Key Considerations

On the positive side, a Cardiac PET imager can provide you with the capability to offer additional tests and enter into new markets. Many of the cameras come with the option of CT, so you might consider adding calcium scoring or coronary vessel imaging to your offerings.

Like Attenuation Correction SPECT, PET imaging has the ability to reduce the number of false positives and can ultimately lower the number of unnecessary cardiac catheterizations. It will, however, impact the activity of your cath lab, which needs to be factored into your plan.

With the addition of Cardiac PET, payers may also view your practice differently. PET MPI scans have a high reimbursement, which means your facility will be submitting a higher claim. This may result in greater scrutiny across all of your tests.

Lastly, when looking at PET MPI, it’s important to determine where it’s going to physically fit in your practice. PET imagers are larger than Echo, EKGs or even SPECT cameras and the radiopharmaceuticals have specific space requirements. You’ll need to identify a 15’x20’ – 20’x30’ room to accommodate a PET camera.

Aiming for Balance

The ultimate goal for any physician is to be able to order the right test, for the right patient, at the right time. Cardiac PET is a valuable tool that can help you provide the best care for your patients and help you achieve that goal.

As you evaluate the camera, it’s important to look at the entire picture. The camera price and its ongoing costs are major drivers, but those alone can’t determine your decision. It’s critical to evaluate how all of your diagnostic imaging services will work together after the initial purchase.

Reimbursement Radar: How 2019 rule changes from CMS will affect cardiologists

Posted on: 12.13.18

On November 23, 2018, the Centers for Medicare & Medicaid Services (CMS) published the final rule changes for the 2019 calendar year. How will they affect nuclear medicine and your practice in particular? After all the noise in 2018, the changes were minimal. It seems that 2019 will be following suit:

Hospital procedure rates remain nearly static

On the hospital side, CMS has continued to evaluate and adjust the cost of procedures that are either under- or overvalued. The majority of nuclear medicine procedures will see a minimal increase of between 0.5% and 2.2%. The slightly more significant but far from dramatic adjustments will be made to codes for administering radiopharmaceutical therapies, which will see a decrease of 3.3%.

Fewer measurements

One notable change was made in direct response to the administrative burden that meaningful use measures and quality reporting placed on providers. In 2019, not only will no new meaningful use and quality measures be implemented, but CMS will look to reduce the current policy. The reduction is aimed at allowing providers the ability to focus on the measures that are most meaningful and impactful on their patient care.

Site neutrality payment cuts

More interesting, however, was CMS’ decision to neutralize payment variances between the Hospital Outpatient Prospective Payment System and the Ambulatory Surgical Center Payment System. By implementing a Physician Fee Schedule (PFS)-equivalent payment rate for an off-campus provider-based department (PBD) clinic visit that is paid under the OPPS, patients will benefit from high-quality care and lower copayments.

In order to further evaluate the unnecessary increases they’ve seen in services rendered at PBDs, however, CMS will establish a moratorium on the addition of any new off-campus PBDs. Existing locations will continue with business as usual, and CMS will monitor the total amount of payments made under the current arrangements. Any follow up to this issue will likely be addressed in the 2020 or 2021 ruling.

Physician fee schedule sees positive change

Overall, current projections are seeing a negligible increase, barely 1%, in nuclear medicine. Procedure rates are slated to remain largely the same, based on the national unadjusted average.

An additional year for AUC preparation

One of the biggest reliefs in the final ruling has to do with the effective date for adherence to authorized use criteria (AUC), which has been postponed numerous times and last slated to take effect on July 1, 2019. Many of the medical societies voiced their concern about the preparedness of providers and their ability to implement a new system by mid-year. CMS responded by designating 2019 as an education year with a revised effective date of January 2020.

Can you outsource your nuclear lab accreditation?

Posted on: 12.06.18

IAC or ACR accreditation is a critical component of a quality assurance program and directly affects your reimbursements. Considered the industry’s gold standard, accreditation demonstrates adherence to strict national quality standards that ultimately ensure the highest level of patient care.

Accreditation is an ongoing process

The typical accreditation process can be completed in an average of 3 to 6 months and the designation is valid for three years. However, your practice must not only earn the accreditation, but it must also maintain it.

Accrediting associations perform at least one audit per three-year period to confirm the continued delivery of high caliber care, so keep in mind that accreditation is an ongoing effort, not a project that has a completion date.

The challenges of maintaining you nuclear lab accreditation

An effective accreditation program is one that continually allows you to evaluate your practice and successfully holds you accountable to certain standards.

There are multiple facets, reporting requirements, and analysis that, in order to gain the full benefit of the designation, need to be embraced. Much can change in a 3-year period and if your practice doesn’t make the necessary improvements until the eleventh hour, your reaccreditation might be in jeopardy.

With that said, some of the biggest obstacles practices face include the time commitment and resources needed to ensure continued compliance; monitoring continuing education completion, interpreting and implementing guidelines and regulatory changes, updating policies and procedures, running reports, reviewing case studies, and holding quality improvement meetings, are just a few examples.

The benefits of outsourcing your accreditation

Most practices do not have a seasoned employee with accreditation experience on staff and, if they do, they run the risk of their only expert leaving the practice at some future date. So, how do you ensure the successful application and proper maintenance of your accreditation?

Outsourcing the accreditation process is one way to ensure that all aspects of the process are anticipated and accurately completed in a timely manner. Digirad has two solutions for practices in need of accreditation.

Leveraged accreditation

By utilizing one of the Digirad Select packages, you’re able to leverage the Digirad accreditation, which lends accreditation to your practice. Digirad’s multi-location IAC accreditation service makes accrediting your lab fast, easy, and less expensive than committing to the process yourself.

Accreditation consulting

For practices interested in traditional nuclear lab accreditation, Digirad offers a consulting package to assist with the initial accreditation or reaccreditation process.

Digirad’s experts have a comprehensive understanding of the accreditation process and will manage the collection, preparation, submission, and review of the completed application. With expertise in both nuclear and echo accreditation, they will simulate an inspection and help you address the findings so you’ll be well prepared for an audit.

Ongoing, they’ll initiate quarterly quality assurance meetings to review the ongoing maintenance of your accreditation program where they’ll review policies and procedures, make improvement recommendations, alert you to new or revised regulations, and measure your progress.

An investment in quality

Using a consultant can often be a costly option, but Digirad’s tiered pricing approach to accreditation makes it a more affordable option. For a small investment, your application for accreditation could be handled much more efficiently, with the insight of experts, and without unnecessary stress.

Most importantly, you’ll have a program that continually evaluates your practice and works to improve the level of care and service you provide your patients.

For more information on Digirad and the Digirad Select accreditation services, click here.

How to Reduce Gut Activity with Myocardial Perfusion Imaging

Posted on: 11.15.18

We’ve heard of everything from half & half, cold water, and even a certain type of soda post injection to reduce the dreaded gut activity. Since we weren’t aware of any tried and true solution, we polled our fellow nuclear specialists on LinkedIn to see if they could provide some tips, tricks and home remedies.

Wait Time is always going to be your best practice to assist with clearance but if that or your go-to response doesn’t always work, check out these suggestions and add them to your list:

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Katrina B.
If it is a bowel loop, we give them another cup of cold water and have them walk the hallway if they can. If they have a hiatal hernia or liver disease, we give them a longer wait time prior to scan to try to avoid the need for rescan. And we ask them all not to lay down, but to sit up instead when possible when waiting.

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Rhevon L.
In my experience, the most effective method for reducing gut uptake and obtaining separation from the inferior margin is the combination of walking and ice cold water consumption. I have also heard of technologist giving patient’s Boost/Ensure after rest dosing and obtaining great images. This is done at the discretion of exercise stress, however.

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Kim L.
Additional cold water – approximately 8 ounces. Drink fast. Walk around for 5-10 minutes, then have the patient lay on their right side to see if the loop will pull away from the bottom half of the heart. I had a tech that worked for me that came from Ohio State, and they would try this. Sometimes it would work and sometimes it wouldn’t. Always feed them. That, of course, helps for most.

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Michael B.
We find that waiting is the best remedy but not always practical. Cold water gulped down for resting scan. Snack and a drink for the stress scan. Sometimes, particularly with hot livers, lying the patient on 2 pillows behind the shoulders, raising them will drop the activity away from the heart.

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Neda S.
I have used carbonated sodas if walking and drinking water didn’t help. I used to use Diet Sprite, but I guess ginger ale is an option too. For stress images, fatty foods, ice cream, coffee, anything that helps bowel movement.

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Patrick B.
I’ve often placed a broad strip of pliable soft lead shielding over the patient’s abdomen at an angle, and this has often helped mitigate proximal intestinal activity. Otherwise, if you have the time, waiting 45-60 minutes post-injection to perform resting MPI has been fairly beneficial.

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Jeremy W.
I like for my patients to have a drink of their choice (soda, water, coffee, etc.) and some crackers or small snack before their stress images. Some water only before rest images. Extra wait time for Cardiolite vs. Myoview, especially for liver clearance.

Healthcare Quicklinks: Value based care, new ACC accreditation, patient collection mistakes, and more

Posted on: 11.08.18

Physician practices seek help in transition to value-based care

Physicians not affiliated with hospitals are increasingly turning to consulting firms to help them move into value-based care and accountable care organizations (ACOs), according to a new Black Book Research report. A survey of nearly 900 physician organizations showed that 68% of group practices of 10 or more doctors said they will seek “external advisement on financially and clinically transforming their operations” within the next year. Continue reading…

ACC launches new quality accreditation program for excellence in cardiovascular care

The American College of Cardiology (ACC)’s new accreditation program, HeartCARE Center: National Distinction of Excellence, will be designated “forward thinking” hospitals and healthcare systems that demonstrate excellence in cardiovascular care and also “advance the cause of sustainable quality improvement.” The HeartCARE Center designation is now the highest a hospital or healthcare system can receive from the ACC. Continue reading…

Here is how all 50 states, DC rank in patient access

The Mercatus Center within Fairfax, Va.-based George Mason University released its June 2018 update report on patient access to healthcare. The Healthcare Openness and Access Project reviewed state health data to draw comparisons on states’ healthcare flexibility. The ranking leverages the overall HOAP index, which averages 10 equally weighted subindexes that “measure the discretion patients and providers have over broad areas of healthcare, such as public health and telemedicine,” the report states. Here’s how all 50 states and Washington, D.C., stacked up. Continue reading…

CMS seeks input on Stark Law changes amid value-based care shift

The Centers for Medicare & Medicaid Services recently asked stakeholders for input on how to change the Stark Law to allow for better care coordination and new alternative payment models or other novel financial arrangements. The agency specifically is requesting input on what new exemptions to the Stark Law are needed to protect accountable care organization models, bundled payment models and other payment models, including how to allow coordination care outside of an alternative payment model. It also asks for help examining definitions for terminology such as risk-sharing, enrollee, gain-sharing and other terms. Continue reading…

5 common patient collections mistakes

It wasn’t long ago when patient collections were viewed as a minor concern in ASCs. Reimbursement was strong, and what patients owed for their care was relatively low. Then reimbursement started tightening while patient financial responsibility rapidly increased. Since 2015, patients experienced a nearly 30 percent increase in deductible and out-of-pocket maximum costs. It won’t be surprising to see that figure rise even further when Black Book releases its 2018 revenue cycle management surveys. Continue reading…

Deep learning, SPECT-MPI forecast obstructive CAD

SPECT myocardial perfusion imaging (MPI) and deep learning have proven to be a powerful pair in predicting obstructive coronary artery disease (CAD) and improving the interpretation of upright and supine images, according to research published Sept. 27 in the Journal of Nuclear Medicine. The study analyzed stress MPI images from 1,160 patients (64 percent males) from the National Institutes of Health-sponsored Registry of Fast Myocardial Perfusion Imaging with Next generation SPECT (REFINE-SPECT) who underwent upright and supine SPECT MPI in four U.S. nuclear cardiology centers between 2008 and 2015. Continue reading…

SNMMI comments on 2019 proposed hospital outpatient rule

SNMMI and the American College of Nuclear Medicine recently responded to the Centers for Medicare and Medicaid Services’ 2019 Hospital Outpatient Prospective Payment System (HOPPS) Proposed Rule. In brief, SNMMI and ACNM objected to CMS’ proposal to remove three radiopharmaceuticals from the pass-through list for 2019. They also noted that removing two Alzheimer’s drugs from pass-through, while putting another back on pass-through, will make it difficult to obtain coverage for any of the three. Lastly, SNMMI and ACNM asked CMS to clarify that it will continue to provide additional payments for low-enriched uranium. Read thefull letter here.

Brain MR-PET reveals widespread inflammation in fibromyalgia patients

Using MR/PET imaging, researchers from Massachusetts General Hospital (MGH) in Boston and the Karolinska Institutet in Sweden have revealed that elevated glial activation—widespread neuroinflammation—correlates with fatigue levels in patients with fibromyalgia, and may enhance the development of treatment. The research was published online Sept. 14 in Brain, Behavior and Immunity. Continue reading…

How patients and providers benefit from CT lung cancer screening

Posted on: 11.01.18

Lung cancer is a leading cause of cancer deaths. One reason is that the signs and symptoms don’t present themselves until the disease has already progressed. By taking advantage of low-dose CT lung cancer screenings, high-risk patients can reduce their chances of dying from lung cancer by as much as 20%.

Screening eligibility requirements

Under the Medicare and Medicaid guidelines, a patient must meet the following criteria:

Be between the ages of 55 and 77
Be asymptomatic of lung cancer
Have a tobacco smoking history of at least a one pack per day for 30 years or 2 packs per day for 15 years
Be a current smoker or former smoker who has quit within the last 15 years

Patients who satisfy the eligibility requirements will meet with a qualified health professional for a lung cancer screening counseling session. The session is designed to result in a share-making decision about the patient’s upcoming test results.

If anything suspicious is found, the patient and healthcare professional will develop a treatment route to pursue. If it comes back normal, there’s always the recommendation that the patient continues to get the scan on an annual basis until they no longer meet the eligibility requirements.

What happens during the screening test?

The test itself is quite simple. It’s essentially a chest CT-scan that does not require any preparation. After answering a few screening questions, the patient will lay down on the scanner and hold their breath for ten seconds during the scan. There is no IV or contrast administration needed.

The screening is a significant benefit to the patient. Although they’re considered high risk due to their lifestyle, they’re also asymptomatic at the moment. In the event of a positive result, the identification of lung cancer at any stage before it shows signs or symptoms offers the patient a higher chance of survival.

Patient and Facility Benefits

The benefit to the patient and the effect on their survival rate are most important, but there are additional benefits to the facility that provides the screening service. As they continue to serve the community and identify people early in their cancer journey, the facility is continually establishing themselves as a lung cancer treatment center.

The earlier a patient begins treatment, the higher their survival rate…and the better the statistics for the hospital. In the age of Google, when families are searching for a treatment facility, those with higher survival rates will be looked upon more favorably.

It also provides a financial benefit for the facility. From a business perspective, the lung cancer screenings and diagnostic CTs don’t generate a tremendous amount of revenue, but the treatment, radiation therapy, surgery, and chemotherapy utilize a broad spectrum of services at your facility.

Outsourced CT Imaging

If your facility is reaching maximum capacity for CT imaging, or does not currently offer on-site CT, there is the option of outsourcing it to a mobile provider like DMS. As an extension of your facility, DMS can provide their state-of-the-art equipment at your location to perform the screenings and ultimately complement your efforts.

It’s a worthwhile service for your patients and the community, and it financially supports your organization without putting the extra burden on your staff. For more information on DMS and how they can help support your efforts, visit their website.

Practical pre-authorization tips for nuclear imaging

Posted on: 10.25.18

In today’s economy, everyone is looking to save money and reduce costs, including insurance companies. This has translated into an increasing level of scrutiny when it comes to ordering nuclear imaging studies.

Pre-authorization is now an accepted part of the process, but the requirements and rules are getting more and more complex. In this post, we’ll take a look at ways to better navigate the process.

The pre-approval process

The pre-approval process is used by health insurance companies to verify that certain drugs, procedures, and services are medically necessary before they’re completed.

The quickest way to gain approval is through strict adherence to appropriate use criteria, but it also requires detailed, clear, and complete documentation in the patient’s clinical record.

Documented records should include the patient’s chief complaints, diagnosis, and the results of prior testing that are consistent with a particular treatment plan.

Major roadblocks and how to avoid them

One of the major hurdles is the amount of time that pre-approvals consume and thus detract from other patient-centered tasks in the office. It’s important for staff to have all the information handy before they start the process. The insurance company will have detailed questions, and the staff will need to provide the appropriate answers in a timely manner.

If an insurance company representative senses any lack of confidence, disorganization, or hesitation on the part of the office staff, they can use that to their advantage, which can quickly slow down the approval process.

It’s expected for insurers to require additional information, and sometimes a peer-to-peer review, when the conversation offers up the opportunity to ask for more. You need to be prepared for the possible roadblocks ahead of time.

If your organization is large enough, staff members tasked with managing pre-authorization can work at developing relationships with insurance representatives from particular companies. Leveraging that relationship and specific payer protocol is a smart idea. Chances are they’ll have a higher rate of success because they’ll know what the insurer is looking for and how to manage it.

The benefits of outsourcing pre-authorization

Frustration and the time investment are some of the most common reasons a practice gives up pursuing in-house pre-approval. To combat those hurdles, many practices outsource the approval process to a third-party, like MDBoss for instance, who specializes in pre-certification.

For a practice that lacks the manpower, does not have experienced staff, or the time to spend on the phone with insurers, it can be a cost-effective solution. Many outsourced providers charge based on a per-study basis so even small clinics can leverage the service without worrying about minimums or expensive retainers.

The insurance landscape is continually changing. Many insurers are hiring third-parties themselves to manage their approval process. There is also a push from some insurers, like Humana, BCBS, and Cigna, for locations to become approved test sites. It requires a lengthy summary that includes camera serial numbers, staff credentials, certifications, and other key information, that can easily overload small practices.

The pre-certification or pre-authorization process is an essential part of the services that a physician’s office provides to their patients. There are ways to make the process run smoother, but it takes time, dedicated staff, and a lot of patience.

If your in-house attempts are not producing the desired results, determine the most common hurdles and work quickly to overcome them. It’s in the best interest of your business, your patient’s health, and their financial well-being.

DMS completes ISO-9001 Certification, certified mobile PET/CT provider

Posted on: 10.18.18

DMS Health Technologies, a leading provider of Mobile MRI, PET, and CT imaging, recently announced that it has obtained ISO-9001 certification. ISO 9001 is the international standard for quality management systems (QMS).

What is ISO-9001 certification and why does it matter?

Organizations in various industries leverage the ISO-9001 standard as a way to demonstrate their ability to consistently offer products and services that meet these specific requirements.

In the healthcare sector, standards help minimize errors, reduce redundancy, lower costs, and increase customer satisfaction. It’s critical for a provider like DMS to offer quality equipment to hospitals and bring the same level of care to their patients, especially when they’re operating as an extension of the hospital.

Covering everything from product fulfillment and maintenance to overall quality management, ISO offers a framework for identifying non-conformance and provides corrective processes. Each step is a chain of events, a series of inputs and outputs, and when they’re successfully connected to each other to work as an effective process, it provides the most efficient path to quality.

Imaging Equipment and Services

For DMS equipment, the certification was focused on how to fulfill an order and execute the deliverables within the contract. The DMS team expects their equipment to arrive on time, be clean, well maintained, and ready to go.

The ISO certification didn’t just help with the leasing side of their business. On the service side, delivery included DMS staff that provided diagnostic imaging on the hospital’s patients. With DMS’ ISO certification, hospitals can have peace of mind that both equipment and services comply with standards of excellence, which allows DMS to represent the hospital well.

When you leverage DMS Health Technologies, either for products or services, they serve as an extension of your organization. The ISO 9001-2015 certification is just one more way that DMS has demonstrated their commitment to the satisfaction of their customers and to the overall quality they provide.

MedAxiom Fall 2018 CV Transforum Conference Preview

Posted on: 10.10.18

MedAxiom’s annual Fall 2018 CV Transforum Conference will be held in Austin, Texas from October 11-13, 2018.

The Live Music Capital of the World will host over 6,800 physicians and more than 400 cardiovascular organizations as they come together to share information and experiences, network with their esteemed peers, and discuss key industry trends. Attendees will be introduced to transformational programs and hear from the nation’s top leaders.

This year’s keynote presentation will focus on the state of our industry in a market that is being led and developed to support self-insured employers. Other general session topics include telehealth and virtual medicine, physician alignment organizations and payer platforms, and the latest regulatory and legal developments in Washington.

With additional detailed breakout presentations and intimate POD group discussions, attendees will have multiple opportunities to gain in-depth insight and real-world solutions to the challenges we face as an industry.

If you want to maximize your trip, head to the pre-conference area where you can tackle a content-rich boot camp for new APP Provider leaders or take a dive deep into exploring quality metrics and compensation formulas.

Digirad is proud to be an exhibitor at the 2018 Transforum Conference again this year. We’d love to introduce you to our wide range of solid-state imaging solutions or answer any questions you may have about our products, services, or support. Be sure to stop by the Exhibit Hall and say hello.

See you in Austin!

What is the Role of Cardiac Cath in Value-Based Care?

Posted on: 10.04.18

It’s an undeniable fact that the move to value-based care is changing cardiology. Cardiac catheterization, in particular, has evolved as appropriate use criteria and value-based care have continued to advance in the healthcare system.

This once go-to procedure is now being replaced by new methods and less invasive techniques. In this post, we’ll take a look at where cardiac cath fits in today’s value-based landscape.

How we got here

Years ago it was common for the cath lab to be the first stop for patients experiencing symptoms of cardiovascular disease. It was a valuable diagnostic procedure with solid reimbursements and relatively little oversight from payers. Today, the rules have changed.

In many ways, the cardiac cath landscape changed after the American College of Cardiology published the 2009 AUC for Coronary Revascularization.

As Medicare and CMS developed their guidelines, the criteria became more and more a part of the cardiology landscape. Additionally, the way payers approach cardiac catheterization has continued to evolve. Increased scrutiny is being added to the procedure while reimbursement rates continue to decline.

Lately, these factors have been compounded as significant penalties for patient readmission and not following AUC have been added.

The move to non-invasive techniques

It’s said that necessity is the mother of invention, and this has held true for how cardiologists are approaching cardiac catheterization in the current market.

We are seeing a rise of new non-invasive diagnostic tools as a way to mitigate lower reimbursements, penalties, and improve patient care.

Cath is still an essential tool for both patients and cardiologists, but now physicians are wanting more evidence and clarity before ordering the test. Non-invasively obtaining proof that disease exists has now become step one in the process.

The impetus behind these changes makes sense on a number of levels. The net result of doing more tests before the cath lab is that cardiologists are performing fewer invasive and unnecessary procedures. This is good for the patients and the healthcare system as a whole. While a reduced study volume does affect the bottom line, it is also resulting in the practice experiencing lower readmission fees and penalties for not following AUC.

Non-invasive methods gaining traction

Fractional Flow Reserve

Many cardiologists are choosing to utilize fractional flow reserve, or FFR, as a way to diagnose heart disease and guide clinical management. It non-invasively measures the difference between the maximum achievable blood flow in the presence of stenosis and the theoretical normal maximum blood flow in terms of pressure using coronary artery images.

FFR simulation is able to more accurately identify those patients who have a high likelihood of disease. So, not only does the method comply with the stricter enforcement of AUC, but it has also improved the percentage of catheterizations that ultimately result in an intervention.

Advances in SPECT

Nuclear SPECT studies play a vital role in the diagnosis of cardiovascular disease. The nature of SPECT makes it a perfect fit for value-based care, but too often the clinical value of SPECT depended on the reader.

New advances in SPECT imaging are bringing Attenuation Correction into this modality. The addition of Attenuation Correction is making images clearer and easier to read.

The studies and the cameras, such as the Digirad X-ACT+, are considerably more affordable compared to traditional CT imaging. This creates a tremendous amount of value – both clinically and for the healthcare system.

Cardiac PET

As imaging technology continues to advance, Cardiac PET MPI is gaining more awareness in today’s clinical market. In recent years, the modality has seen growth and is generating interest among cardiologists.

While the diagnostic benefits of Cardiac PET are clear, the cost and complexity of offering the modality have kept it from being a realistic option for most practices.

Medical Therapy

It’s also important to consider how medical therapy is changing cardiology. Research has shown that moving straight to medication as opposed to investing in diagnostic procedures is an effective way to treat patients.

The Bottom Line on Cardiac Catheterization

Cardiac Catheterization and Percutaneous Coronary Intervention will obviously continue to play a vital role in cardiology. As technology continues to advance, non-invasive methods will become more effective and more affordable.

As an industry, we may continue to see fewer cath tests ordered but they will be ordered with more clinical confidence. In the end, these changes benefit the patient while also reducing the financial risk to the practice and the healthcare industry as a whole.

This post was written in partnership with MedAxiom and includes contributions from Jacob Turmell DNP, RN, NP-C, ACNS-BC, CCRN-CMC and Joel Sauer.

How changes to Section 179 can positively affect your bottom line

Posted on: 09.27.18

If you own a private practice and are considering the purchase of new or pre-owned medical equipment, the recent revisions to Section 179 of the IRS tax code, which were included in the Tax Cuts and Jobs Act, could offer some significant tax advantages. Here’s a quick look at some of the changes and how they might motivate you to make a purchase sooner than later.

What is Section 179?

Section 179 was added to the IRS tax code as an incentive for business owners to invest in themselves, grow their market share, and improve their chances for long-term success. It allows for accelerated depreciation of equipment, including machinery, computers, software, office furniture, vehicles, and other tangible goods. Although large businesses benefit from Section 179’s tax treatment, the legislation’s original intention was to provide much-needed tax relief for small businesses like private practices.

For much of Section 179’s history, it offered a relatively small tax deduction, but beginning in 2003, Congress began increasing the expense limits and deductions while expanding the list of qualifying equipment. The 2018 revisions to the tax code are the most generous and advantageous to date.

Generous updates to Section 179

As a result of the newest revisions, business owners are able to deduct 100% of the purchase price, lease price, or financed amount of qualifying equipment, as long as it was acquired and put into service during the same tax year. The code previously applied to only new equipment but has been expanded to include pre-owned equipment as well.

Prior to 2018, the maximum equipment deduction was $500,000, but effective on January 1, 2018, that amount was increased to $1 million. In addition, the new legislation raised the annual maximum spending threshold from $2 million to $2.5 million and set the 2018 bonus depreciation rate at 100%.

Consider your next step

Upgrading or purchasing new equipment is an smart way to invest in your practice. With these tax advantages, it may be time to reevaluate your needs. Talk with your tax advisor and see how the new Section 179 tax treatment might offer you the opportunity and the motivation to take that financial leap.

For more information on Section 179, including a list of qualifying items, an illustrated calculation example, and an interactive tax deduction calculator, visit the official website.

5 Ways Cardiologists Can Increase Referrals From Primary Care Physicians

Posted on: 09.20.18

The patient volume that’s generated from physician-to-physician referrals is a significant factor in the success of any cardiology practice. In fact, some studies suggest that as much as 45% of new patients were received by referral.

With a host of cardiologists vying for their referral business, primary care doctors need to feel some level of comfort in recommending one over the other. To earn the confidence of other physicians and, in turn, their referrals, you’ll need to actively work on differentiating yourself and your service from the rest of the pack. Here are some practical ways to increase referrals from your network of primary care physicians:

1. Cultivate your relationships

The most obvious way to grow referrals is to leverage your existing relationships with primary care physicians and work at building new ones. Most of the time, physicians refer patients to specialty practices where they know the doctors and the staff. They have a firm understanding of the comprehensive services they offer, confidence in their skill, knowledge of their reputation, and assurance that they’ll provide referred patients with excellent service at the next level of care. Cultivating those relationships is critical.

Take initiative in getting to know not only the primary care doctors in your referral network, but also the office staff. Remember their names and learn some things about their families or their hobbies. When you take an interest in people, it makes an impression.

Developing a relationship from scratch is a little more work. See what information you can find about a new primary care physician and find a connection. Where did they go to med school? Are they a diehard Mets fan, or do they follow the Atlanta Falcons? Do they play golf, or run marathons? Reach out to them, introduce yourself, and ask how you can meet their needs. Invite them to your office for a tour, some introductions, and lunch. Afterward, take the time to send a hand-written note thanking them for stopping by.

It’s important to remember that real relationships take time, and you probably won’t see results overnight. If you continue to cultivate your relationship with them, you’ll climb to the top of their referral list.

2. Make referring physicians look good

Primary care physicians want to know that you’re taking good care of their patients and treating them right. When they refer their patients, your office serves as an extension of theirs and a reflection of what they value, so make a memorable impression.

Patients routinely report back to their primary care physicians about their experience with a specialist and the care they provided. Appointments should be able to be booked in a reasonable amount of time and patients shouldn’t have to wait more than 15 minutes to be seen.

Most importantly, report back to the primary care physician quickly and if it’s the very first referral, follow up with a phone call thanking them for their confidence and trust. Finally, don’t be afraid to ask for more referrals. Simply ensure the primary care physician that there will always be room for their patients at your practice.

3. Commit to becoming a full-service cardiology practice

Most primary care physicians don’t want to refer their patient to you, only to have you refer the patient to another specialist, hospital, or office location for an additional test. In order to keep and grow your referral base, it’s important to be as much of a full-service provider as possible.

Becoming a full-service provider involves staffing your office and investing in state-of-the-art equipment that can perform the most comprehensive range of tests and services. Referring physicians choose specialists who are best prepared to offer the highest level of care coupled with the advantages of the latest technology.

If you’re unable to purchase new equipment or hire new staff you can use a mobile imaging service to provide a wider range of services inside your office. The full-service approach is a key differentiator and one that can help lead you to the top of your game.

4. Share your knowledge

Primary care physicians appreciate being kept up to date on developments in your field. Whether it’s a few extra minutes on a phone call about a particular case or a quarterly newsletter you distribute, find opportunities to share your specialty.

Host an open house for referring physicians and their staff to introduce them to new equipment, view a demonstration, or even test drive a new software program. Provide drinks and light snacks and encourage attendance with a door prize, like a gift card, for example. It’ll give you and your staff an opportunity to get to know them better in a relaxed setting without distractions.

Are there any specific topics that may be interesting to your referral network and their staff? From procedures to new technology to patient satisfaction, invite a guest speaker, or speak on a particular topic yourself.

5. Survey your primary care physicians and their staff

Asking the right questions can help you determine what’s working and what areas need improvement in the eyes of your primary care physicians. Periodically, it’s a smart idea to create a survey or hire a third party that specializes in referral network and peer-to-peer surveys, to help you gain a clearer and more comprehensive view of your practice. Once you review the results, you’ll be able to make improvements and resolve some specific issues.

Share the final results with your network. You’ll be able to brag about the positive feedback and announce the changes you’ve made to improve upon any shortcomings. It’ll also show that you care about meeting the needs of your referral network and you’re committed to quality service and care.

How much does it cost to offer Cardiac PET?

Posted on: 09.13.18

While the diagnostic benefits of Cardiac PET are clear, it’s important to understand the financials and investments needed to offer the service before making a commitment. In this post we’ll explore five aspects to consider as you evaluate Cardiac PET.

1. Equipment Requirements

If you decide to offer PET imaging, you’ll need to choose between the purchase of a new imaging system, or refurbished. It’s common for pre-owned options to be 8-10 year-old traditional PET cameras that have been refurbished to factory standards for technology and performance.

Many of these older cameras use line sources to perform attenuation correction. Generally, the camera and attenuation correction sources are considered the acquisition component. It’s often bundled with a new processing workstation that employs some of the latest cardiac processing features, including coronary flow information.

Depending upon the manufacturer, a refurbished system can cost between $350,000 and $450,000, but because there is limited availability in the secondary market, they’re also subject to the law of supply and demand.

An additional factor in the equipment equation should be your maintenance and repair costs, which, for a pre-owned system, will typically range from $80,000 -$85,000 annually.

If you’re considering a refurbished model, it’s important to do business with a reputable company. Keeping quality and service in mind, a trustworthy organization will help you find the best fit for your investment.

The alternative option is to purchase a new PET MPI camera. Most modern PET imagers include a CT component that provides attenuation correction. Most new PET/CT imagers cost over $1,500,000 and are a significantly higher investment than the cost of a refurbished model.

New cameras come with various levels of CT sophistication, some of which can perform calcium scoring and coronary vessel imaging. If you’re contemplating the larger investment, you might want to consider purchasing the most sophisticated camera your budget can afford, and offset the cost by the additional tests you can offer your patients.

It’s important to remember that regardless of which new PET/CT model you choose, you’ll need to spend 10-12% of the purchase price for annual repair and maintenance costs.

Many cardiology practices choose the refurbished route. When you do the math, depreciating $350,000 over 72 months is a lot easier to digest than $1,500,000 over the same time period. The sticker shock alone prevents some practices from considering the more sophisticated tests.

2. Radiopharmaceutical Expenses

The radiopharmaceuticals used with PET MPI are a significant component of the monthly cost in offering the modality. If you’re using the Rubidium-82 radiotracer, you can expect to pay between $40,000 and $45,000 each month, depending upon your study volume, the size of your generator, and the length of your contract. Supply contracts are generally a minimum of 1 year but are typically negotiated for 3-year terms.

13n-ammonia is an alternative radiotracer, but its practicality and cost make it prohibitive. A unit dose solution, however, is known to be in clinical trials, which may or may not lead to commercial availability within 3-5 years.

3. Staffing Considerations

If your practice is offering SPECT imaging in-house, your current nuclear technologist should have the educational background and licensing required to perform PET studies as well. While they may not have direct PET/CT expertise, your technologists can easily be trained. The only procedural difference between SPECT and PET MPI is the type of stress imposed on the patient. SPECT imaging includes both chemical and mechanical while PET includes only chemical stress. It does not require the use of a treadmill.

When you purchase a PET camera, the manufacturer will include applications training, as will the generator or cyclotron company.

Depending upon your volume, one technologist may be able to manage the workflow. You might also consider adding an assistant if an additional technologist isn’t warranted. Generally, adding PET MPI to your services should not affect your staffing, unless, of course, your volume is such that both your SPECT and PET imaging are significant enough to require an additional team member.

4. Facility Requirements

Adding a PET camera to your office may require some site planning considerations. The PET camera is significantly larger than the typical SPECT camera. Since you’ll be keeping your SPECT camera, you’ll not only need additional space, it will also have to be larger than what you have allotted for your SPECT camera. A 15’x20’ – 20’x30’ room could accommodate a PET camera, depending on the manufacturer. The space will also need to be lead-lined for radiation shielding. If your office square footage is tight, consider building an addition or even acquiring other real estate either in your current building or at another location.

5. Regulatory Expenses

Some states in the U.S. require physicians to apply for a Certificate of Need (CON)to install a PET camera. The goal of the CONprogram is to control health care facility costs and facilitate the coordinated planning of new services. Approval is not guaranteed as they reserve the right to determine the necessity of an additional PET camera in a particular area. If you live in one of these states, be sure to factor in the cost and time of submitting your application.

There may also be additional taxes or fees assessed by some states for high-end imaging. In that case, a percentage of the revenue from your PET studies may be payable to the state government.

How to leverage mobile imaging when facing a natural disaster

Posted on: 09.06.18

In times of disaster, the demand for immediate emergency healthcare services can quickly surpass an area’s capacity. Most disasters are localized, and residents who are sick or injured depend on the care, services, and expertise provided by the local hospital. It’s critical for the hospital system to have an effective recovery and management plan in place.

Here are some considerations for designing a comprehensive, multi-faceted, and scenario-driven approach to disaster response:

Disasters are unpredictable

In the aftermath of a disaster, patients in need of care will instinctively head to the nearest hospital. Most disaster recovery plans address preparation for the onslaught of emergencies, overcrowding, and insufficient personnel. But, you also need to plan for the possibility that the facility may be unreachable for some. Roads may be impassable due to flooding, landslides, or debris. Transportation services may be limited, or the hospital itself may be damaged or inoperable.

How to prepare for the worst

Under any conditions, hospitals need to be resilient. They need to be able to absorb and respond to the shock of a disaster, continue to provide critical functionality and work quickly to recover to their original state. Sometimes that may require the help of an outside organization who can fill the gaps and bring imaging and emergency clinical services to the community.

A well-designed recovery plan should most certainly consider partnering with a mobile health care provider that, when necessary, can respond quickly and arrive at any location with the critical staff, supplies, and equipment.

In preparation, it’s important to research your vendors. Before the emergency you should use due diligence to identify providers who are reputable and have the appropriate credentials like ISO 9000 accreditation and the Joint Commission (JCAHO) certification. They’ll have the policies and procedures already in place and have the support structure, too. In doing so, you’ll ensure the same high quality of care for your patients, regardless of who administers it.

How will service be delivered?

A mobile healthcare unit is comprised of a fully equipped, furnished, tractor-trailer with onboard equipment powered by a generator. It can be parked at almost any location that has a flat surface. Asphalt is ideal because its surface is firm and level, but tightly packed gravel is an option in certain cases.

Once it’s delivered to the designated site, the staff will set up the equipment and establish the electrical and internet connections. These mobile units can provide CT, MRI and Ultrasound imaging as well as acting as a freestanding medical clinic.

The mobile healthcare company can provide a team of fully functional personnel to operate the unit, but their personnel can also provide on-site ad hoc equipment training to your staff in order to provide a continuum of care.

What information will we need to provide?

During a disaster, the following information can help decrease response time and significantly increase a mobile unit’s preparedness.

1. Network information

Providing network information in advance of arrival allows the unit to establish a connection as quickly as possible and minimize start-up time.

2. Identification of an alternative site, as needed

Potential alternative sites should be identified well in advance of any disaster, if possible. Whether it’s an empty parking lot, a football field, or any other location, permissions should be in place prior to the mobile unit’s arrival. It’s also helpful if on-site power is identified, rather than relying on the onboard generator.

3. Staff

It’s important to have an accurate count of your available staff and be able to communicate your additional personnel needs. Upon the unit’s arrival, there should be a key staff member who can take charge of the unit and give direction to the team.

4. Resolution of specific state regulation conflicts

Any specific state regulations that can complicate delivery of services should be identified in advance. For example, some mobile healthcare companies may not be registered in all states, and special prior approval may be needed.

Planning is not a prerequisite

While partnering with a mobile healthcare company in advance is the best approach to managing any disaster scenario, it’s not a prerequisite. Mobile healthcare companies can often respond on-demand and together you can still create a customized plan as you go.

The most important thing is that people receive the necessary medical attention and can trust their local hospital to continue to provide the highest level of quality care, even in the face of disaster.

Join Digirad at ASNC 2018 in San Francisco

Posted on: 08.30.18

Grab your suitcase and join Digirad at the American Society of Nuclear Cardiology’s 23rd Annual Scientific Session. From September 6 through 9, 2018, we’ll be at the Marriott Marquis Hotel in the sunny city by the bay, San Francisco, California.

This year’s theme, Bridging Quality Imaging and Patient Care, will bring together cardiologists, radiologists, practice administrators, and other healthcare professionals from around the world to discuss emerging research, new technology, and advances in nuclear cardiology.

What’s new?

Brand new for 2018 is show-stopping keynote speaker, Tait Shanafelt, MD, Director of the Stanford WellMD Center and international thought leader. He’ll share insight on how to find meaning, balance and professional fulfillment in the practice of medicine.

Other first-time features include an imaging-based case management track, hands-on PET and SPECT simulation, a walk and learn tour with past ASNC presidents, deep dives on machine learning, molecular imaging, and other fast-evolving innovations, and more. Plus, 2018 marks ASNC’s 25th anniversary. You won’t want to miss this milestone celebration!

Visit us at Booth #401

While you’re there, be sure to visit the Exhibit Hall to learn about the latest advances in nuclear cardiology technology and professional services. Digirad is thrilled to be among the exhibitors at this year’s meeting. Look for us in Booth #401 where we’ll be showcasing the Cardius® X-ACT+ SPECT/FAC camera. We’ll also have team members on hand to discuss cardiac PET solutions. Stop by and see us!

For more information about the event, click here to visit the ASNC website.

A Closer Look at the Digirad Ergo (Infographic)

Posted on: 08.23.18

Download a PDF version of this infographic

Medicare PET/CT Reimbursement for Oncology: What’s covered, what’s not

Posted on: 08.16.18

PET/CT is a vital diagnostic imaging tool and is especially effective in revealing conditions such as cancer and brain disorders. When it comes to Medicare coverage, there are a number of misconceptions about PET/CT reimbursements.

In the majority of cases, PET/CT imaging is covered when clinically necessary, either as an initial treatment strategy or a subsequent treatment strategy.

Few exceptions apply to specific breast and cervical cancer, and melanoma diagnoses. The initial treatment of prostate cancer is the only non-covered event. Below is a consolidated reference chart that details PET/CT insurance reimbursement for specific conditions.

Tumor Type	Initial Treatment Strategy	Subsequent Treatment Strategy
Brain Cancer	✓	✓
Breast Cancer (female & male)	*CWE	✓
Cervical Cancer	*CWE	✓
Colorectal Cancer	✓	✓
Esophageal Cancer	✓	✓
Head & Neck Cancer (not thyroid or CNS)	✓	✓
Lymphoma	✓	✓
Melanoma	*CWE	✓
Myeloma	✓	✓
Non-Small Cell Lung Cancer	✓	✓
Pancreatic Cancer	✓	✓
Prostate Cancer	Non-covered	✓
Ovarian Cancer	✓	✓
Small Cell Lung Cancer	✓	✓
Soft Tissue Sarcoma	✓	✓
Testicular Cancer	✓	✓
Thyroid Cancer	✓	✓
All other solid tumors	✓	✓
All other cancers not listed	✓	✓

*CWE = Covered w/ exceptions

Cervical: Nationally non-covered for the diagnosis of cervical cancer related to initial anti-tumor treatment strategy. All other indications for initial anti-tumor treatment strategy for cervical cancer are nationally covered.

Breast: Nationally non-covered for initial diagnosis and/or initial staging of axillary lymph nodes. Nationally covered for initial staging of metastatic disease. All other indications for initial anti-tumor treatment strategy for breast cancer are nationally covered.

Melanoma: Non-covered for initial staging of regional lymph nodes. All other indications for initial anti-tumor treatment strategy for melanoma are nationally covered.

Leukemia: Nationally covered under “all other cancers not listed.”

Prostate cancer (dx 185.0) is not covered for initial treatment strategy. Therefore, all PI modifiers for 185.0 would be denied and PS modifiers would follow the same frequency as other cancer diagnosis codes.

7 critical considerations for practices considering de-integration

Posted on: 08.09.18

After a significant wave of practices choosing to merge with hospital systems, physicians are starting to consider de-integration and returning to private practice.

It seems that integrated health care, the solution that many thought would be the answer to a variety of our healthcare industry’s challenges, might not have the impact or the endurance it was thought to have. As many healthcare organizations continue to expand, practitioners are contemplating their next step.

Should they work together and become even more woven into the organization? Or, do they throw in the towel and start taking steps to re-establish their private practice? While some might prefer to cut ties, the decision to separate the hospital system brings with it a lot of uncertainty.

Factors to Consider

Each practice has its own unique situation and there is not a clear-cut answer for everyone. Selling your practice to a larger system was not an easy decision, so buying it back, or de-integration shouldn’t be either.

It’s critical to weigh all the information and make a decision that meets your needs, your patients’ needs, and those of a successful business. Here are some key considerations if you’re thinking about diving into de-integration:

1. Evaluate your patient base and payer mix

While the patients in your new private practice may be better insured, they’ll also be a highly sought-after slice of the market that many will compete for. With this type of change, your practice could potentially experience up to 40% erosion in existing patient base. That’s a significant decrease in volume that shouldn’t be ignored.

2. Assess your insurance contracts

The benefit each insurance contract delivered across your entire partner hospital was likely a weighty negotiating factor. Specifically review the reimbursement levels for physician services to see if they’re feasible to continue at the current rate. On the bright side, your potential new status could also offer the opportunity to discuss contracting with the same insurers for additional services.

3. Evaluate available new revenue streams

Raising rates is not the answer, especially in a competitive market, so finding other sources of income is a necessity. Consider adding back the ancillary services that integration did not allow, like in-office x-rays and lab services.

4. Consider your billing and collections system

After de-integration, you’ll need to employ a third-party billing company, or invest in your own computer system and hire people with the necessary skills. Since your patient base will experience some erosion, it’s critical that you’re able to effectively manage billing and maximize collection rates.

5. Determine new group membership

With any group of providers, not all may be on the same page or ready to take the next step. Discuss expectations, goals, interests, and the potential new group’s needs, which will ultimately help determine which providers should be included in the new medical group.

6. Manage the compensation discussion

The integrated solution likely came with a more generous salary option than a private practice can manage. As owners, providers must be willing to accept responsibility and tie compensation, to some degree, to their productivity. It’s an about-face from the reliable and predictable salary arrangement they had as an employee of the integrated system. In addition, the employee benefits package may suffer as well, making it a somewhat less attractive option for qualified, experienced staff.

7. Consider the size of your staff.

When re-establishing your practice, or branching out on your own for the first time, you have to watch your bottom line. While a hospital may have provided ample staff, you’ll need to decide where you can cut back, where to ramp up, and the different levels of service providers your practice requires.

The Bottom Line

In order to responsibly evaluate the opportunity to return to or move to private practice, accurate assumptions around patient volume, staffing, services, revenue, and operating costs are critical.

Be realistic and understand that any new venture will likely carry debt from the buy-back, as well as additional start-up costs. It’s all part of running a business, but if you do the work upfront, the end result should come without any major surprises.

Four important ways Cardiac PET Perfusion Imaging can affect your profitability

Posted on: 08.02.18

In today’s economic climate, practices are looking for additional services that will benefit their patients while also positively affecting their bottom line. Some cardiologists are exploring the idea of offering PET imaging at their facility. While convenient, in-house PET scans may not be the right fit for every practice. The smartest and most informed decision should take into account these four important factors.

1. Radiopharmaceuticals

Consumables for cardiac PET are unlike those used for SPECT imaging. The two commonly available radiopharmaceuticals for the modality include a 13N ammonia based product and 82Rubidium.

The exceptionally short half-life of the advanced ammonia-based radioactive tracers used for PET imaging, 15O water and 13N ammonia, is a significant challenge that in almost all cases, requires an on-site cyclotron.

Most providers offering PET use a 82Rubidium tracer, which can be produced by an on-site generator. While it delivers similar results and is less costly than the ammonia-based tracer, it’s still a considerable investment, often costing more than $40,000 a month for the rental of the generator.

2. Preauthorization Considerations

An often cited dynamic of Cardiac PET is that it does not require Medicare preauthorization. While this makes the ordering process more manageable, it’s important to remember that there is a critical distinction between pre-authorization and pre-approval.

Pre-authorization is not necessarily a green light for payment approval. All the existing rules still apply and, once evaluated, Medicare has to agree with the clinical validity of the decision. As the procedure becomes more popular, Medicare and payers will continue to increase their scrutiny and regulations surrounding reimbursement.

3. Patient Volume

Patient volume is a critical factor when evaluating Cardiac PET. Statistically, 20-30% of SPECT patients receive inconclusive results and clinically qualify for a PET scan for future follow ups. In order to cover the overhead, a set number of scans will need to take place each month.

If your volume is in the gray area after factoring in the 20% referral rate, it’s worth carefully looking at the numbers. Given their higher patient population, large organizations, universities, and hospitals are typically a good fit. But again, the total reimbursement must also be considered.

If the organization is not a free-standing clinic, the Medicare reimbursement code is written so that only the cost of the study is reimbursed. Expenses related to the 82Rubidium generator are excluded from hospitals, and they are only allowed to bill for the procedure.

In this ever-changing regulatory environment, rules and reimbursement rates will be modified over time. In calculating your expectations, whether it’s patient volume, cost, or reimbursement rates, you also assume the risk of change…for better or for worse.

4. Exchanging SPECT for PET

Remember, too, that your estimated PET studies per month will ultimately reduce your SPECT study volume. It’s essential that you accurately forecast your SPECT and PET revenue since an increase in one will inversely affect the other. Double counting the number of scans is a mistake some Pro Forma’s make and ultimately leads to unmet expectations after the financial commitment has been made.

The Bottom Line

While financials are a critical consideration, the value of a PET scan in a patient’s diagnosis and the outcome is also significant. While SPECT is a vital part of any cardiology practice, the ability to offer a PET scan could confirm or deny the need for invasive surgery. For the right cases, it saves money, time, and unnecessary risk for patients, surgeons, and insurers across the board.

It’s not an easy decision, by any means. There’s no denying that PET adds clinical value, but the financial aspect is also a practical consideration in any business. If it’s not financially feasible in your practice, and your recommended course of action is a PET scan, referring a patient to the local hospital is still the smart option. It could be a simple solution to a complex problem, and one that ultimately supports the highest level of care for your patients.

World Lung Cancer Day – August 1st

Posted on: 07.26.18

This upcoming Wednesday, August 1^st, is World Lung Cancer Day. As healthcare providers, we feel that it is important to help raise awareness of the disease and discuss what can be done to combat it.

According to the American Cancer Society, lung cancer is the second most common cancer in both men and women – second only to prostate and breast and prostate cancer. With over 234,000 new cases of lung cancer being diagnosed each year, the chances of developing the disease are 1 in 15 for men and 1 in 17 for women. With statistics like these, it is important that we know what symptoms to look for and what we can do to prevent it.

Signs & Symptoms

Unfortunately, the majority of people that develop lung cancer are asymptomatic, or do not have any signs or symptoms, before the cancer starts to spread. Some individuals do experience early symptoms that help to detect the cancer before it spreads but it is not as often as the medical community would like. Some of the most common symptoms of lung cancer are:

Shortness of breath
Persistent cough that lingers or gets worse over time
Cough that produces a bloody or concerning looking phlegm
Consistently feeling tired or weak
Loss of weight or appetite
Chronic respiratory infections – bronchitis, pneumonia, etc.…
Wheezing

Early Detection

There is hope thanks to advances in technology and medicine. As detection methods are improving, so are the odds of overcoming early stage lung cancer. One of the best screening tools out there is a low dose CT (LDCT) lung cancer screening.

What is a low dose CT lung cancer screening?

LDCT lung cancer screening is exactly as it sounds – a CT or CAT scan involving a minimal amount of radiation. The exam itself takes only a few seconds while most of the time spent at the imaging facility is either registering at the front desk or walking back to the CT department. Luckily, there is no need to have an IV or contrast injected as part of the routine screening exam.

Can anyone have a LDCT lung cancer screening?

Right now, to qualify for a LDCT screening exam, there are a few criteria that must be met. Keep in mind, newer healthcare procedures tend to evolve over time and this is what the American Cancer Society currently recommends (all criteria must be met):

Be a current smoker or have quit within the past 15 years
Have a 30+ pack year smoking history: This equation for this is: (# of years smoked) x (# of cigarettes per day) = pack years
Example: (15 years of smoking) x (2 packs per day) = 30 pack years
Received counseling to quit smoking if they are current smokers
Have been informed by their physician regarding the potential benefits, limitations and harms associated with LDCT screenings
Have a facility where they can go to receive LDCT screenings and treatment

Resources

Digirad and DMS Health Technologies are available to help your facility or clinic establish a LDCT screening program. Don’t have a CT scanner? No worries, we can help with that.

There are many resources out there on lung cancer, smoking cessation, patient and family support. A few great places to start are:

2018 ASNC SPECT MPI Imaging Guidelines Issued

Posted on: 07.19.18

Recent advancements in SPECT Myocardial Perfusion Imaging prompted ASNC to issue updated SPECT guidelines, which were published on May 25, 2018.

The highly anticipated new guidelines, ASNC Imaging Guidelines: Single Photon Emission Computed Tomography (SPECT) Myocardial Perfusion Imaging—Instrumentation, Acquisition, Processing, and Interpretation, incorporate the most up-to-date information and advancements in SPECT technology since the previous 2010 ASNC SPECT guidelines were published.

Today’s SPECT technology effectively allows for exceedingly low radiation dose imaging, myocardial blood flow quantitation, and personalized imaging protocols. By leveraging the new advancements, the revised guidelines promote a more patient-centric and personalized approach that contributes to higher-quality imaging and more meaningful results.

The medical community considers the update a significant move toward the standardization of SPECT MPI and one that will ultimately allow them to provide patients with the highest level of customized care.

The new guideline features updates on novel hardware, collimators, and CZT scanners, as well as newly added sections on reduced count density reconstruction techniques, SPECT myocardial blood flow quantification, stress-first/stress-only imaging, and patient-centered myocardial perfusion imaging.

The guidelines were endorsed by the Society of Nuclear Medicine and Molecular Imaging and published in the Journal of Nuclear Cardiology. You can view and download the new guidelines from ASNC’s website and read the official press release here.

Four new revenue streams for cardiologists

Posted on: 07.05.18

Operating a financially successful practice requires a daily focus on operational concerns, but it also necessitates seeking new opportunities for revenue streams. Many cardiologists overlook opportunities to offer ancillary services that will boost practice income.

Here are four revenue streams that could increase efficiency, referrals, and patient volume, while improving patient care and satisfaction across the board. As the market moves toward value-based services, these are worth considering:

1. Cardiac rehabilitation clinic

After a cardiac event, many patients are hesitant, even fearful, of exercising. Consider establishing a cardiac rehabilitation clinic where patients can safely work out, raise their heart rates, and improve physical function all under the supervision of a trusted doctor.

To qualify as a rehabilitation clinic, Medicare requires the program to include a medical evaluation and a comprehensive program that helps modify cardiac risk factors. Exercise and nutrition counseling and overall lifestyle education are critical components. You might also offer blood pressure and stress management, lipid management, and a smoking cessation program. While CMS provides reimbursement for up to 36 sessions, a self-pay maintenance program that continues after reimbursed services end could be especially profitable.

There are some costs to consider, however. A physician must be on the premises, so it’s critical to find space within your building. You’ll also need to hire an exercise physiologist and a medical professional who can provide education. While it’s a great way to stay connected with your patient base, it’s also a place where patients will be comfortable and feel a sense of camaraderie with other patients while they improve their health and reduce risk factors.

2. Device services

With more than 180,000 new pacemakers and defibrillators implanted every year, adding a maintenance service might serve you well. Pacemakers should be tested every three months, and batteries only last between six and ten years. Based on the size of your practice, an in-house service might make financial sense and contribute to the caliber of your overall patient care. It would allow you to follow your patients as you check for battery depletion, pulse generator malfunction, lead malfunction, and pacemaker pocket erosion. Between in-home monitoring, interpretation, and office visits, the revenue can add up quickly. With a large patient population, an extension of your device services could include group education and support for patients and families.

3. Chronic care management

While not exactly new, recent changes in the Physician Fee Schedule make it much easier for physicians to provide CCM services to their Medicare patients. Easier enrollment into the CCM program, the elimination of face-to-face visits for existing patients, no longer requiring separate consent forms, and additional reimbursement for time beyond the standard 20 minutes makes it much more financially attractive. The creation of a care plan will also boost reimbursement as will the treatment of moderate and high complexity patients.

The goal is better care coordination, the results of which have been well documented. But, the challenge is how to execute and operationalize this method of patient management. Several third-party vendors provide automated CCM programs that can help physicians manage their chronic care patients in a way that easily and successfully captures the maximum reimbursement.

4. Medication adherence program

With approximately 50% of all prescriptions not taken as directed and 25% of which are never picked up from the pharmacy, medication adherence is a significant problem in our healthcare system. If physicians had the opportunity to dispense the initial pack of medication at the point-of-care, it would not only increase compliance, but it would also generate an additional revenue stream. The program does not add any cost to the practice, or the healthcare system, and can be easily integrated into your current office workflow. By leveraging the physician-patient relationship, patients would be better educated on the need for medication adherence, and it would simplify the prescription process.

A medical adherence solution could also be tied to more effective chronic care management. CCM patients take multiple pills at different times of the day, and in a different order, so smartly designed, calendarized, compliance packaging or a simple conversation with a familiar and trusted CCM professional could easily prevent a mix-up–or a potential catastrophe. In the end, a medication adherence program could allow you to provide complete care and better outcomes, both that contribute to the greater satisfaction of your patients.

Making a wise choice

While additional revenue streams are attractive, you should evaluate each opportunity carefully and with proper consideration. Look for services that will best serve the size of your practice and the needs of your patients. Determine the cost of implementation and the potential to differentiate your practice, increase your reach, and attract new patients. Making an informed and educated choice to add additional services could be one of the most important business decisions you make.

Why you should rethink PET/CT imaging for prostate cancer

Posted on: 06.28.18

The large majority of the nuclear imaging community would be quick to point out that PET/CT imaging with either 18Fluorodeoxyglucose (18FDG), or Sodium 18Fluoride (NaF18), is not effective in prostate cancer diagnosis. In fact, it’s not even approved for initial prostate treatment strategy.

With oncology imaging, most other cancers are green-lighted for both initial and subsequent treatment strategies. Prostate imaging, however, is only approved in the latter.

Radiopharmaceuticals and diagnosis

Because prostate cancer is a slow growing, less aggressive disease, the common sugar-based FDG is not an effective agent for diagnosis, but it can be used appropriately to identify metastasis in the body during subsequent treatment.

Sodium 18Fluoride (NaF18), has been used in bone imaging and was previously covered through the National Oncologic Pet Registry (NOPR). However, when the radiopharmaceutical reimbursement was discontinued in December 2017, it lost some of its popularity among physicians. Based on the NOPR study results, coverage is expected to be addressed in the future.

While prostate cancer is consistently one of the top three cancers in the nation, there are very few effective imaging solutions. Blood work, specifically through monitoring the prostate-specific antigen (PSA) level, delivers the majority of diagnoses. Any deviation from normal is an indicator, and may lead to surgery, cryotherapy, or radiation, as necessary.

One new radiopharmaceutical, two benefits

The relative newcomer to prostate cancer detection is Axumin (18F-Fluciclovine), which is indicated for PET imaging in men with suspected prostate cancer recurrence based on elevated PSA levels following prior treatment (chemical recurrence). By continuously monitoring PSA levels following treatment, Axumin can be used as soon as PSA levels begin trending upward leading to quicker detection.

Other imaging methods rely on physical changes in the body, whereas Axumin detects changes on the physiological level, which can develop weeks, even months earlier than physical changes. It ultimately presents a huge opportunity to fill the void in prostate imaging solutions.

An Axumin PET scan accurately identifies the cellular activity and location of a reoccurrence. While 18FDG is ideal for soft tissue, and NaF18 for bone imaging, Axumin offers the best of both worlds. Imaging studies show skeletal mass and metastasis throughout the body, including the prostate bed. When using Axumin, the imaging process begins right away and there is little to no bladder uptake visualized, whereas the traditional method of imaging with 18FDG typically has a great deal of bladder uptake. This bladder uptake, in some cases, obscures residual prostate cancer that may be in the prostate bed or regional lymph nodes.

The challenge with Axumin is its availability. It is currently available from only a handful of radiopharmacies throughout the U.S. and is only produced on certain days, with doses available during a short window of time. However, additional manufacturing sites are planned for 2018.

Understanding Your Nuclear Medicine Stress Test

Posted on: 06.21.18

Myocardial Perfusion Imaging, also called a Nuclear Stress Test, is used to assess coronary artery disease, or CAD. CAD is the narrowing of arteries to the heart by the build up of fatty materials.

CAD may prevent the heart muscle from receiving adequate blood supply during stress or periods of exercise. This frequently results in chest pain, which is called angina pectoris. Perfusion imaging usually consists of stress and rest tests.

Images are taken of your heart while at rest and after exercising or under stress. The comparison allows your physician to evaluate blood flow under different levels of exertion. After the images are reviewed, they’ll meet with you to discuss the results.

Understanding Your Nuclear Medicine Stress Test

Normal or abnormal, what does it mean?

A normal test result indicates there is sufficient and unrestricted blood flow to your heart, both during periods of rest and exercise. Generally, there’s little concern for coronary artery disease and, in most cases, you won’t require any further testing.

An abnormal result, which means your heart’s blood flow is insufficient, may occur only during the exercise phase of your stress test. During rest, your blood flow may be normal, but during strenuous activity, when your heart is working harder, it may not be getting the blood supply it needs. It’s likely that there is some level of coronary artery disease or blockage.

An abnormal result in both phases of your stress test is an indication that your heart’s blood flow is poor, regardless of your exertion level. The restricted blood flow suggests significant coronary artery disease. If your stress test images show areas of the heart that are not highlighted with the radioactive isotope, it may also be an indication of scar or damaged tissue caused by a previous heart attack.

Regardless of the results, your doctor will explain the findings and address your concerns. If necessary, they’ll recommend a treatment plan that can potentially improve or better manage your heart’s function.

Quicklinks: Hospital cost cutting, enhancing the patient experience, and more

Posted on: 06.14.18

Healthcare is ever changing, so it’s important to stay up to date on advancements and issues that may impact the operation and growth of your business. Here are some relevant conversations and important developments happening in our industry as of late:

Hospital costs should be cut 24 percent by 2022 to break even, outsourcing may help, survey says

Hospital leaders are exploring ways to outsource services to free up resources, and if the results of a new Black Book survey are any indication, this strategy will come none too soon. In order to break even, average hospital costs will have to be reduced by 24 percent by 2022 and, according to the survey, hospital leaders are determining whether to work with third-party vendors for cost efficiencies in both clinical and nonclinical functions. Continue reading…

CMS debuts strategy to improve rural healthcare

The Centers for Medicare & Medicaid Services (CMS) recently unveiled the Rural Health Strategy, a plan to take proactive steps to ensure rural communities receive quality and affordable access to healthcare. The new policy aims to advance programs that help to meet the healthcare needs of nearly 60 million people living in rural areas across the country. Continue reading…

PiB-PET study strengthens link between amyloid, dementia

According to a study published online in JAMA Neurology, the presence of amyloid on PET scans may be a sign that adults with no symptoms of dementia are still at risk of mild cognitive impairment or even Alzheimer’s disease as they age. Researchers conducted PET scans with carbon-11-labeled Pittsburgh Compound B (PiB-PET) and found that adults ages 50 to 59 who had amyloid were twice as likely to develop dementia by the time they reached their 80s compared with age-matched counterparts with no signs of amyloid accumulation. Continue reading…

4 elements that enhance patient experience

During AONE 2018’s keynote presentation, Chip Heath, an expert in organizational behavior at Stanford Graduate School of Business, spoke on the importance of creating positive moments and how they have the potential to influence a patient’s healthcare experience. During his talk, The Power of Moments: Why Certain Experiences Have Extraordinary Impact, he discusses how moments have the power to jolt, elevate, or change a person. Nurse leadership can build these peak moments that will stick with patients for a lifetime and improve a patient’s healthcare experience through the use of four elements. Continue reading…

Addressing productivity, labor to bend the healthcare cost curve

From alternative payment models and value-based purchasing to artificial intelligence and data analytics tools, the healthcare industry is transforming how care is delivered and paid for to reduce constantly rising medical costs. While payment reform and health IT bring promises of reduced costs and increased productivity, there’s doubt as to whether can these efforts truly bend the healthcare cost curve. Continue reading…

Glucose and beyond? Experts debate optimal targets for managing CV risk in diabetics

For diabetic patients with or at risk for cardiovascular disease, experts at the 2018 European Atherosclerosis Society (EAS) meeting agree that glucose management should not be the only treatment target, but how much priority it should take compared with other risk factors remains an open question. In the past, interventional studies did not show any type of improvement in the cardiovascular outcomes. Now there is data that can reduce cardiovascular outcomes in patients with diabetes if the correct treatment is used. Continue reading…

Cardiology societies release consensus on ionizing radiation in cardiovascular imaging

A new expert consensus document that guides the optimal use of ionizing radiation in cardiovascular imaging was published in the May 2, 2018 online edition of the Journal of the American College of Cardiology. The document offers best practices for safety and effectiveness when using computed tomography (CT), nuclear imaging, and angiographic/fluoroscopic imaging. Its purpose is to assist cardiovascular practitioners in providing optimal cardiovascular care when employing ionizing radiation in diagnostic and therapeutic procedures. Continue reading…

Visit Digirad at the SNMMI 2018 Annual Meeting

Posted on: 06.08.18

The Society of Nuclear Medicine and Molecular Imaging (SNMMI) 2018 Annual Meeting will be held at the Pennsylvania Convention Center in historic Philadelphia, Pennsylvania from June 23 through June 26.

Join the over 5,000 leading nuclear medicine and molecular imaging professionals, including physicians, radiologists, cardiologists, pharmacists, scientists, and lab professionals, who will visit the City of Brotherly Love to experience the world’s premiere scientific, educational, research, and networking event.

This year’s conference was condensed to four days, but it certainly doesn’t skimp on content. Choose among more than 195 accredited CE and scientific sessions, 800+ scientific posters, and countless networking events. You’ll also have the opportunity to connect with over 170 trendsetting companies–the ones responsible for driving change in our industry–in the world-class Exhibit Hall. Take time to engage with industry experts, explore the latest emerging technology, and learn about the innovative new products and services that will help you stay ahead of the curve.

While you’re there, be sure to visit Digirad at Booth #657. We’ll be proudly exhibiting our QuantumCam, X-ACT+, and Ergo™ Imaging Systems. Stop by and see us!

The role of PET/CT with pulmonary nodule workups: what you need to know

Posted on: 05.25.18

It’s a common misconception in nuclear medicine that a patient must have a cancer diagnosis before a PET/CT scan can be ordered. While this is generally true, many physicians are not aware that a solitary pulmonary nodule that measures less than 4cm qualifies for a PET scan without a prior cancer-confirming biopsy.

Avoiding Unnecessary Risks

Lung nodules are typically discovered via chest x-ray or CT and available guidelines for nodule management are generally based on nodule size or changes.

The wait-and-see approach is a standard recommendation for nodules under 4cm. The patient is given CT scan and then rescanned on a pre-determined schedule (every six or 12 months). This approach works well if the risk is in-fact low, but for patients who do have metabolically active nodules, this approach can have serious consequences. Properly identifying and diagnosing the cancer early can have a far-reaching impact on their long-term prognosis. Waiting to see if the nodule gets worse costs valuable time.

However, the reason most physicians chose the wait-and-see approach is that the alternative, a lung biopsy, also presents risks. For small nodules that may or may not be growing, many doctors decide that waiting is safer than subjecting the patient to a potentially unnecessary invasive medical procedure. Lung biopsies are a vital diagnostic tool, but they bring with them the risk of infection, collapsed lungs, bleeding in the lung, etc.

Gaining Clarity with PET/CT

The central issue physicians deal with in these situations is how to deal with the unknown and juggle the risks associated with both paths. With PET/CT imaging, you have a much clearer picture of what is actually happening within the nodules. Having this vital information makes the decision much easier and drastically reduces the risk for the patient.

For nodules that are not metabolically active during the PET/CT scan, it’s not recommended to follow up with a biopsy. So patients avoid the risks of an unnecessary procedure. However, if the nodule positively reacts to the radiotracer, further investigation and a biopsy are strongly recommended. Knowing this sooner, rather than later, saves the patient valuable time.

Additionally, in the new “value-based” culture we operate in, investing in a single PET/CT scan could save the healthcare system tens of thousands of dollars in unnecessary scans, biopsies, or advanced cancer treatments. It’s the right thing for the patient, and the system. That is precisely why Medicare covers it.

PET/CT vs. CT

In the wait-and-see approach, most physicians recommend having a series of follow-up CT scans. While CT scans are effective, PET/CT is more accurate than CT alone for characterizing pulmonary nodules, resulting in fewer equivocal findings and higher specificity. Low to intermediate risk nodules ≥ 8 mm should be evaluated by PET/CT, whereas high-risk nodules should be biopsied or excised.

In over 80% of indeterminate CT scans, PET/CT correctly characterizes lung nodules. Statistically speaking, PET/CT is far superior to CT in terms of diagnostic accuracy in solitary pulmonary nodule characterization. PET/CT is 97% sensitive, has an 85% specificity value, a 92% negative predictive value (NPV) and a 93% positive predictive value (PPV). Overall, PET/CT imaging provides 92% accuracy when diagnosing SPNs.

Industry Recommendations

The Society of Nuclear Medicine recommends that FDG PET/CT exams should be routinely obtained in the diagnostic work-up of solitary pulmonary nodules. Imaging will improve health care outcomes, mostly by avoiding futile surgeries in low-risk patients and enabling curative surgeries in high-risk patients.

PET/CT is approved by CMS for characterization of solitary pulmonary nodules not exceeding 4 cm to determine the likelihood of malignancy. Claims should include evidence of the initial detection of a primary lung nodule, usually by computed tomography. SPNs recommended with a PET/CT follow up using ICD 10 code R91.1

Although the Fleischner Society generally recommends a wait-and-see approach for nodules under 8cm, the under 4cm requirement for PET scan approval is causing many physicians to reevaluate their care strategy. PET/CT scans are a useful screening tool that clarifies where the patient actually stands.

Ergo brings advantages to First Pass scans in Canadian market

Posted on: 05.17.18

St. Michael’s Hospital in Toronto, Ontario is a teaching and research hospital renowned for providing exceptional patient care. The hospital’s Digirad Ergo Imaging System recently gained attention for its use in multi-gated acquisition scans (MUGA) combined with First Pass scans to assess both right and left ventricular function.

An Ideal Paring

The Ergo, a single-head gamma camera, performs the noninvasive diagnostic test that evaluates the percentage of blood pumped through the lower chambers of the heart. Because the First Pass and stress MUGA scans offer sensitivity as well as improved specificity to myocardial perfusion imaging, the study is an important offering that effectively measures wall motion when a patient’s heart rate is at its fastest. First Pass scans can lead to higher quality images, fewer artifacts, and higher diagnostic confidence.

The Ergo’s large field of view, portability, and clinical versatility were factors that weighed in the hospital’s purchasing decision. The ability for the camera’s head to be positioned closer to the patient, and the arm’s unique swing feature, which allows the technologist to image a variety of angles of the heart, made the Ergo an advantageous choice.

Ergo at Work in General Nuclear Imaging

In addition to First Pass, St Michael’s also uses the Ergo for general nuclear imaging, including gastric emptying, renal, parathyroid, and even lung scans. Because of its flexibility, the camera serves as a fallback option so they can offload any acute work when their primary SPECT camera experiences downtime for repair or maintenance.

By adding an Ergo to their imaging portfolio, the team of radiologists and cardiologists at St. Michael’s have access to a solid-state, portable, and high-quality imager that allows for unmatched utility. For more information on the Digirad Ergo Imaging System, click here.

QuickLinks: 4 ways to cut down on no-show patients at your practice, and more

Posted on: 05.10.18

4 ways to cut down on no-show patients at your practice

The Elmont Teaching Health Center, a federally qualified health center, cut its patient no-shows by 34%. That’s significant given that missed appointments cost up to 14% of anticipated daily revenue at clinics and can also result in longer wait times and can hurt care quality, health outcomes and patient satisfaction. The steps that Elmont took to reduce the number of no-show patients can help other practices or even other businesses that are hurt when customers don’t show up for appointments. Continue reading…

Drug that treats psoriasis also reduces aortic vascular inflammation

An antibody used to treat the skin disease psoriasis is also effective at reducing aortic inflammation, a key marker of future risk of major cardiovascular events. Researchers from the Perelman School of Medicine at the University of Pennsylvania, in collaboration with the National Heart, Lung, and Blood Institute, led a randomized, double-blind, placebo-controlled study and found patients who took the drug ustekinumab had a 19 percent improvement in aortic inflammation, as measured and confirmed by imaging, when compared to the placebo group. Continue reading…

Montreal Parkinson Risk of Dementia Scale deemed accurate

The office-based, eight-item Montreal Parkinson Risk of Dementia Scale is a valid predictor of development of dementia, according to a study published online in JAMA Neurology. Colleagues from McGill University in Montreal conducted a multicenter study using four diverse Parkinson’s disease cohorts with a prospective 4.4-year follow-up to examine the predictive validity of the Montreal Parkinson Risk of Dementia Scale. A total of 717 patients with Parkinson’s disease were recruited; 607 were dementia-free at baseline and followed for one year or more. Continue reading…

Imaging tracer specific to bacterial infections shows early promise

It may be possible to distinguish infection from inflammation with maltodextrin imaging agents, according to one rat study looking at these tracers to catch infections early on for implanted cardiac devices. One such tracer, maltohexaose conjugated with fluorescent dye, accumulated at one hour after injection in a model of subclinical device pocket infection in rats and persisted over 24 hours. Continue reading…

Pulmonary hypertension at baseline doesn’t raise mortality after TAVR

More than three-quarters of patients undergoing TAVR present with some degree of pulmonary hypertension, but this has no bearing on subsequent mortality, researchers have found. Rather, what matters most is whether the condition persists after TAVR. Pulmonary hypertension is one of the many risk factors that enter into decision-making for TAVR operators and heart teams. In fact, pulmonary artery pressure is one element of the EuroSCORE. Continue reading…

The future of cardiac monitoring – what’s changing and what you need to do about it

Posted on: 05.03.18

Since the 1990s, cardiac monitoring devices have evolved from transmitting data via a phone line, to wirelessly, to now leveraging Bluetooth and cellular technology. Although the process of cardiac monitoring hasn’t changed significantly, the devices are much smaller, have fewer pieces, and are more comfortable for patients to use. Let’s take a look at where cardiac monitoring is headed and what the future holds.

Back to the future…

The most recent trend in cardiac monitoring relies on a tried-and-true method from the past – Holter monitoring. Many cardiologists and physicians have started using long-term Holter monitoring as a way to capture more data and improve diagnostic accuracy.

The release of a Medicare code for an extended Holter has made it a viable alternative to newer, long-term monitoring options that are not yet guaranteed for reimbursement. Wearing a Holter for up to a week dramatically increases the amount of diagnostic data that is captured and is proving to be much more useful than a traditional 24- or 48-hour Holter.

Where cardiac monitoring is headed

While Holter monitoring remains popular, manufacturers and developers are using technology to redefine the future of cardiac monitoring.

The future of cardiac monitoring hardware development is centering around the creation of a one-piece monitoring system that has a transmission component built into the form factor. Additionally, given the challenges with returning and maintaining inventory, it’s likely that cardiac monitors of the future will evolve into a cost-effective and disposable version that patients simply throw away when the monitoring period is complete.

On the software side, today’s new platforms are cloud-based, which allows for more power and greater capabilities. The cloud offers more algorithm computation power as compared to the device. This power provides improved specificity, accuracy, and sensitivity. In the future, manufacturers will be able to push updates directly to a network of devices from the cloud and automatically upgrade subscribers to the most current software version.

Everyday personal wearable devices that include monitoring, like the Apple Watch or Fitbit, will also undoubtedly play a role in cardiac monitoring. In the future, apps will accurately provide two-way communication between physicians and their patients. It’s not far-fetched to think that a watch or similar device could recognize a cardiac abnormality and lay the foundation for more targeted cardiac tests.

The limitations of technology

While technology has and will continue to drive the size and capability of cardiac monitoring, it hasn’t been able to automate or improve on the art of reading test results, which still requires an educated and highly trained staff.

While advanced software and algorithms are crucial in improving healthcare, without skilled cardiac trained registered nurses to read the data, alert doctors to authentic abnormalities, and communicate the appropriate urgency, it doesn’t matter how or to what degree it’s been captured. The human side of cardiac monitoring remains vital in the diagnostic process.

In time…

It’s undeniable that technology will continue to impact the future of cardiac monitoring. Smarter software and algorithms combined with cheaper and more accurate devices will continue to improve results. For truly futuristic advances, accuracy and reliability are significant factors that need improvement. However, science, technology, and innovation are continually working together, and these possibilities will, in time, become a reality.

Seven mistakes to avoid when choosing between a new and refurbished nuclear camera

Posted on: 04.26.18

With the continual advancements in healthcare technology and service, investing in your cardiac practice, upgrading equipment, and improving efficiency is an ongoing process. One of the most significant considerations is not only when to replace a camera, but also if refurbished, or new equipment might be a better decision.

It’s important to take the time to look beyond your immediate imaging needs and consider the long-term goals of your practice. Both refurbished and new camera systems come with advantages, but be sure to consider these factors before signing on the dotted line:

1. Focusing only on purchase price vs. the long-term cost of ownership

A nuclear gamma camera is a significant investment for any practice, so it’s natural to focus on the cost. There are times when prioritizing price is a smart idea, but only when the product still retains an acceptable level of value. There are many refurbished cameras that have a considerable amount of life left and could be a wise investment.

When you evaluate new versus used equipment, consider how much image quality has improved in recent years, the availability of new software programs, and the viability of the camera’s current operating system. When the camera is in need of repair, will parts be readily available and will the manufacturer agree to service it? Some manufacturers include a firm end-of-service date on their equipment, which leaves you at the mercy of third-party service providers and replacement parts. Some service companies may even decline service because of age, limited part availability, and the associated risk.

2. Overlooking the ability to maintain image quality

Older, refurbished cameras may undoubtedly be in working order, but their boards and analog methodologies could be less effective. With age, the camera’s light pipe, which includes crystals that eventually yellow and crack, will no longer respond, sometimes without warning. Replacement crystals for older cameras may not be available. Even with newer refurbished cameras, the crystals have already aged, may be hydrated, and are potentially unfixable. Be sure to inquire about and examine the crystals if you’ve considering a refurbished camera.

3. Putting your HIPAA compliance at risk

Another important factor to consider is HIPAA compliance. Many refurbished cameras cannot be upgraded to current software versions, and, because they’re no longer supported by the manufacturer, they can’t they be patched securely. Consequently, the camera cannot be connected to a network because internet access imposes new risks. You also may not be able to add additional processing programs and, in the end, may be forced to purchase an entirely new software package, which will be costly.

4. Not factoring in the credit rating of the practice

While many physicians may have excellent credit, they may not be willing to put their personal credit history on the line when purchasing capital equipment such as a nuclear gamma camera. Instead, they opt to leverage the business credit, and this can have a direct impact on the approval process and interest rate.

If the practice does not have an extensive credit history, it’s more challenging to secure a loan, and interest rates are likely higher on pre-owned equipment. Additionally, if a financial institution feels that you may have issues with part availability on refurbished systems, they may be hesitant to approve a loan for older medical equipment. Be sure to discuss the details and get loan pre-approval before the sales process begins.

5. Failing to consider the true patient volume

Volume is another important factor to evaluate when deciding between used or new equipment-or even whether to outsource your imaging services completely. Not all cardiac practices need a camera on site five days a week. If you’re imaging one, two, or even three days a week, you might consider partnering with a mobile imaging company.

Your volume should factor into your financial investment. Without it, the lack of revenue wouldn’t warrant spending dollars on maintenance costs and might eventually lead to a decline in the integrity of the equipment.

6. Purchasing camera that offers limited use

Any new or used camera that you plan to purchase should be able to expand and grow with your practice. A camera should be able to fill your current imaging needs, but also serve your practice in other ways. Would it lend itself to increased productivity, improved efficiency, and greater patient satisfaction? Sometimes it may be worth the extra investment if it allows you to move forward on another strategy that has the potential to increase revenue or to reach other goals.

7. Not performing your own due diligence

Lastly, knowing from whom you’re purchasing your equipment is of critical importance. An investment of this size should only be made through a reputable company with a proven track record, especially if it’s a refurbished camera. Prepare a due diligence checklist and take the time to get better acquainted with the camera, just as you would with a home, used car, or any other purchase in the second-hand market. Ask to see it, or have it inspected by an independent service company, and ask for the repair and maintenance records.

It’s well within your rights to investigate the camera’s history, current value, and the likelihood of any future issues before making a final commitment. If you don’t, you’re exponentially increasing your chance of winding up with a lemon and having no recourse.

Cost shouldn’t be the only consideration when buying a camera. It may be high on your list, but the value it brings to your practice should be well worth the money you spend.

How practices are making the shift to Value-Based care

Posted on: 04.19.18

When you think about positioning your practice for success and overall sustainability, the transition to value-based care should be one of the first things that comes to mind. The shift from the fee-for-service model is no longer a trend, but a critical necessity in today’s healthcare environment. The value-based approach is the future of patient care and resisting–or even hesitating–will cost your practice the loss of potential revenue and overall viability.

The central idea behind value-based care is to create a system that is not measured solely by services rendered. Its objective is rooted in redefining quality care by enhancing both patient outcomes and experiences, and improving the health of the patient population, while ultimately reducing the increasingly high costs of healthcare.

Transitioning to this new school of thought will include modifications to organizational workflow and a move away from episodic care. Here are a few practical steps you can take as you prepare your practice for value-based success.

Know your patient population

Under the value-based reimbursement model, patient analytics is a critical factor in population health management. Patients with the highest risk of hospitalization, such as chronic or complex conditions, typically incur the highest health care costs. They’re also the ones who suffer most from fragmented care. Identifying this population will help you isolate areas for improvement.

Analytics also use trends to reveal gaps in care by identifying individual patients who may be accessing health care outside of the traditional channels. For example, when and why do patients visit an urgent care facility or emergency room? Is it after hours or on the weekend? Had they been recently discharged from the hospital? Implement a solution that drives utilization toward a high-quality, lower-cost alternative. Ultimately, patients must feel their needs are being met without going outside the box. In some instances, enrolling patients in a care transition program might be the answer.

Analytic software can also help you identify other unnecessary costs. Compare costs for imaging services used by your practice or the cost of supplies. Your findings may reveal that an imaging center used by your practice is more expensive than another comparable one in your area. That’s an easy way to reduce expenses.

Invest in the right technology

With value-based care reimbursement, it’s critical to employ the technologies that support your overall goal. Clinical decision support tools provide the knowledge and patient-specific information that enhances decision-making in the clinical workflow and ultimately improves care. By providing a playbook of protocols, these tools eliminate waste by minimizing unnecessary tests. They also improve patient safety by giving providers access to a patient’s complete medical records, a comprehensive view of their overall health, and a method of easily and quickly sharing patient data with other health systems as needed.

Improve patient engagement

Engaging patients in their health and care is a critical component of value-based care. Patients who are engaged have greater knowledge, ability, skills, and willingness to successfully manage their health and are more compliant with doctors’ orders and recommendations. Investing in engagement leads to better outcomes and lower costs, which are both critical in value-based care.

Patient portals are an ideal method of improving engagement because you effectively give patients access to your practice and a level of control that empowers them. Enrollment, visit summaries, online appointment booking, collecting family health history, and email communication are just some examples of the value and efficiency it can offer your practice and your patients.

Couple that with the creation of care teams who follow patients through their care cycle and beyond, you allow for a more longitudinal care approach. This approach can bring about sustainable change in your patient relationships and how they view their care.

Each step on the way to value-based care should be viewed as a learning experience. As these experiences provide you with more knowledge and understanding about what works best, you can make the changes that will better meet your patient needs.

Five ways that cardiologists lose money each year

Posted on: 04.12.18

Every medical practice is a business and while improving their patients’ health is a physician’s ultimate goal, running at a profit is also critically important. The two may seem to be in direct competition with each other, especially when the healthcare industry is marked by escalating costs and a decline in reimbursement rates.

It’s estimated that, on average, practices experience a 10%-15% profit leak. While each practice is different, that could easily amount to over $100,000 each year. Let’s look at the five most common areas where money may be slipping through the cracks.

1. Billing and Collection Inefficiencies

Collecting patient payments, whether directly from the patient or through the insurance company, is one of the most significant obstacles all medical practices face. Failing to bill for services, track payments, and follow up on outstanding invoices causes practices to lose a considerable amount of money each year.

It’s critical to have adequate billing procedures in place and office staff that are expertly trained and can effectively communicate with patients and insurance companies. Front desk personnel should be trained to collect payment due at the time of service, as well as any past due balances. Benefits should be verified prior to the patient’s arrival and reviewed when services are rendered. Every viable payment option should be available in your office and, although some situations may warrant a payment plan, consider offering it only after exhausting all other options.

2. Inefficient and outdated technology

In the financially-stressed medical industry, technology is sometimes viewed as a luxury, when many times, it’s a necessity. In any business, improved technology should make your job easier, save time and money, and improve outcomes. Innovation in health care is no different. Medical practices are continually faced with the need to incorporate new technology, but it’s critical to choose solutions that let you manage your services more effectively, optimize workflow, and improve patient satisfaction. It could be the reason you’re able to reduce staff, attract patients, gain referrals, and ultimately increase revenue. Whether it’s an antiquated camera, an outdated PACS, or a scheduling system from the 1980’s, you need to evaluate your investment with the future in mind.

Thankfully, there are multiple ways to approach a technology upgrade. Purchasing a new or pre-owned system, signing a lease agreement, or even outsourcing services can be smart choices under the right circumstances. Choosing the appropriate technology upgrade can significantly reduce your long-term expenses and improve outcomes at the same time.

3. Improper CPT Codes and Downcoding

Incorrect CPT coding is one of the most common errors among practices, and the reason for it ranges from a simple mistake to downcoding. Downcoding is the selection of a lower billing code than the actual service provided, which can reduce payments by about 50 percent. Practices downcode in an effort to avoid attention from insurance companies and auditors—so much so that they’re willing to charge less than they should. It’s a pattern that not only causes the practice to lose considerable revenue, but it also opens it up to additional scrutiny and subsequent penalties.

4. Insurance Denials

All physicians know that insurance denials are on the rise. Payers are requiring more detailed information and documentation and are kicking claims back for as little as a clerical error. Shockingly, CMS reported that 60% of rejected claims are never resubmitted. That’s a considerable amount of money that could significantly impact your bottom line. Develop a tracking system for insurance payments and denials from each payor. A knowledgeable staff member who is dedicated to insurance claims should work to research the denials, correct them, and re-file the claim. Don’t make the mistake of assuming all insurance denials are correct.

5. Underutilizing your EHR system

Many practices have blamed their losses on their electronic health record (EHR) system. It’s an easy scapegoat, but not really the full story. A study at the University of Michigan found that the underutilization of a practice’s EHR system was the real culprit.

Many practices didn’t implement the operational changes an EHR system affords. It can increase revenue by simply allowing you to see more patients per day or helping with accurate billing codes and single claim submissions. Almost half of the practices they surveyed didn’t benefit at all from the electronic records feature because they continued to use paper. Understanding and taking advantage of the technology already available to you is critical. If not, you’ve not only lost money on your initial investment; you’re losing revenue with every passing day.

While capturing the 10-15% of profit that you’re losing might not be simple, it’s an effort that can pay real dividends. Tasking your administrative staff with addressing these areas can help your practice stay profitable and healthy over the long-haul.

MedAxiom 2018 CV TransForum Conference – Event Preview

Posted on: 04.05.18

MedAxiom, the nation’s leading community-based cardiovascular performance organization, will hold its 2018 CV TransForum Conference on April 12-14 at the iconic Sawgrass Marriott Golf Resort & Spa in Ponte Vedra, Florida. Industry leaders from across the nation will come together to discuss industry trends, advancements in technology, examine practical business applications, and share best practices.

The conference itinerary is packed with unparalleled learning opportunities that ultimately focus on increasing the quality, effectiveness, and efficiency of both your business and patient care. With relevant general sessions and a variety of breakout presentations, attendees will explore the challenges we currently face and strategies to stay ahead of the curve.

Big picture and deep dives

The focus on bundled payments will continue from last year, and the conference will take an in-depth look into the methods for not only choosing a bundle but also how to work efficiently within the bundle methodology. This year’s itinerary explores the processes and protocols that deliver the best outcomes with the lowest possible cost and ultimately seek to identify patient decompensation before it gets too costly and damaging for the patient.

Sessions will also address methods to protect and grow market share, a critical component of the conference, and discuss strategies that will help hospitals and physicians more effectively manage their care.

Notable speakers

Among others, keynote speaker and industry top thought leader will be Dr. David Wolinski, past president of the American Society of Nuclear Cardiology and the head of nuclear cardiology at the Florida-based Cleveland Clinic. Dr. Wolinski will discuss the future of imaging and how to develop a successful PET imaging program. He’ll be joined by Dr. Edward Fry, Chair of the Cardiology Division and CVSL of the St. Vincent Medical Group in Indianapolis, Indiana, who will share his thoughts on the CV healthcare landscape, the key trends, major issues, and the impact they have on our industry today.

Finally, discussions on new revenue streams and cost savings ideas will round out the conference. They’ll touch on the best ways to cut costs and drive revenue while continuing to protect income. It’s all about balance.

Join us!

If you’re a hospital or service line administrator, physician leader, CFO, COO or a technologist, you won’t want to miss this conference. Digirad is proud to be an exhibitor at the 2018 TransForum Conference again this year. To learn more about MedAxiom and upcoming events, visit their website.

PET/CT Imaging New Tracer Guide

Posted on: 03.30.18

The landscape of PET/CT imaging is rapidly changing. Traditionally, physicians have used a sugar based radiopharmaceutical, ¹⁸Fluorodeoxyglucose or ¹⁸FDG, to perform the majority of PET/CT imaging. Over the past 20 years, this imaging agent was the only option available to many facilities across the United States.

Recent breakthroughs in research, reimbursement, and radiopharmaceutical manufacturing have made it so that physicians and patients will begin to have access to medicine that is designed for their unique situations.

RECENTLY APPROVED TRACERS

Prostate Cancer

Indication

Axumin (¹⁸F-Fluciclovine) is indicated for PET imaging in men with suspected prostate cancer recurrence based on elevated blood prostate specific antigen (PSA) levels following prior treatment.

Mechanism of localization

It has been found that there is an over expression of amino acid transporters in certain cancer cells. This overabundance of amino acid transporters is typically easier to identify among normal, healthy tissue than traditional imaging methods. The body recognizes this drug as an amino acid and actively transports it to potential areas of concern.

Why look into this radiopharmaceutical?

Axumin allows healthcare providers to pinpoint the overexpression of amino acids associated with prostate cancer.
Increased visualization of the prostate bed— no bladder interference during imaging, as with traditional ¹⁸FDG.
PET imaging with Axumin can lead to quicker detectionof tumors. Other imaging methods rely on physical (structural) changes in the body for tumor detection, whereas Axumin detects changes on the physiological (cellular) level, which can occur weeks, even months quicker than physical changes.

Prescribing information and use

A standard 10 mCi dose of ¹⁸F-Fluciclovine is provided
Patient is injected and imaged immediately
Exam takes less than 30 minutes from start to finish

Axumin is a great tool for visualizing the prostate bed which can be challenging using traditional methods.

Neuroendocrine Tumors

Indication

NETSPOT (⁶⁸Ga-Dotatate) is indicated for use withPET for localization of somatostatin neureceptor positive neuroendocrine tumors (NETs) in adult and pediatric patients.

Mechanism of localization

⁶⁸Ga-Dotatate binds to somatostatin receptors, with highest affinity for subtype 2 receptors (sstr2). It binds to cells that express somatostatin receptors including malignant cells, which overexpress sstr2 receptors.

Why look into this radiopharmaceutical?

Improved image quality over the traditional Gold Standard

The Gold Standard method of imaging NETs has traditionally been an Octreotide scan

Often times leaves physicians without answers
Takes up to a week to acquire the entire exam
Results are only qualitative

NETSPOT imaging

Results are conclusive
Improved patient satisfaction: no bowel prep needed or dietary restrictions, 3 hours to complete examination
Results are quantitative and qualitative

The FDA has recently approved a therapy for NETs that uses the same Dotatate as the PET imaging agent and replaces the ⁶⁸Ga with ¹⁷⁷Lu. The theranostic (see it, treat it) approach to treatment has finally become a reality!

Prescribing information and use

A patient specific, weight based dose of ⁶⁸Ga- Dotatate is provided
Patient is injected and imaged at 40-90 minutes post administration
Must be off somatostatin receptor blocking agents

Same Patient— Different Outcome

A) Standard imaging using Octreotide

B) Improved tumor visualization and treatment planning using ⁶⁸Ga-Dotatate

Alzheimer’s Disease

Indication

Adults with cognitive impairment who are being evaluated for Alzheimer’s disease and other possible causes of cognitive decline
Currently 3 approved PET/CT imaging agents areavailable: Neuraceq (¹⁸F-Florbetaben), Amyvid (¹⁸F-Florbetapir), Vizamyl (¹⁸F-Flutemetamol)

Mechanism of localization

There are many studies that demonstrate a relationship between increased β-amyloid plaque and Alzheimer’s disease.
The radiopharmaceuticals bind to this β-amyloid plaque.

Why look into this radiopharmaceutical?

Until recently, there was no way to image the presence of the physiological changes associated with Alzheimer’s disease:
A positive scan indicates an increase β-amyloid plaque which is consistent with AD and other cognitive disorders: To be used in conjunction with other neurological testing to establish a diagnosis
A negative scan indicates that there is a low amountof β- amyloid plaque which is inconsistent with a neuropathological diagnosis of AD
Helps to rule out the possibility of AD

Prescribing information and use

Each radiopharmaceutical has its own prescribing and dosing information
Patient is injected and imaged
Entire exam takes less than 90 minutes from start to finish

TRADITIONAL TRACERS

¹⁸FDG

Indications

Cancer—most common
Infection & inflammation
Viable myocardium (cardiac)
Brain – seizure, epilepsy, Alzheimer’s disease, dementia, tumors

Mechanism of localization

¹⁸Fluorodeoxyglucose (¹⁸FDG) is a sugar molecule that concentrates in areas of high glucose metabolism. Healthcare providers are seeking to determine whether there is an abnormal amount of uptake of this tracer in a particular area of the body which may be indicative of a particular health concern.

Why look into this radiopharmaceutical?

This is the most widely used imaging agent in the world of oncology. Many referring physicians are familiar with this drug and its applications for oncologic purposes. It is generally accepted as the drug to use for most cancers.

Many physicians and facilities are not familiar with the other indications and usages of this imaging agent. Examples include: Viable myocardium—this drug can be used to determine what sections of the heart are still viable and have living, functioning cells.

Brain – Many times, ¹⁸FDG can add valuable information that a neurosurgeon needs prior to surgery. Functional changes occur much earlier than physical changes—PET/CT images often compliment CT or MRI images.

NaF¹⁸

Indication

This radiopharmaceutical is most commonly used to identify cancers of the bone or cancers that have metastasized (spread) into the bone. The Sodium ¹⁸Fluoride (NaF¹⁸) ions are deposited directly into the bone matrix and bone surface. Common sites are newly mineralized bone, such as during growth, infection, malignancy (primary or secondary), after trauma, or during inflammation.

Why look into this radiopharmaceutical?

This drug is much better at targeting skeletal activity than FDG and provides a much clearer image than traditional nuclear medicine bone scans. These 3D images are also quantitative which allows physicians to precisely measure the activity within a lesion – allows for a more accurate interpretation of the response to treatment.

Prescribing information and use

The imaging agent is ordered and delivered for each specific patient
There is no patient prep
Patient is injected and imaged
Entire exam takes roughly 90-120 minutes

How to know if Cardiac PET makes sense for your practice

Posted on: 03.22.18

The Basics of Cardiac PET

Although most commonly used when imaging certain Oncology patients, PET cameras can potentially be of benefit to cardiologists for a segment of patients needing myocardial perfusion imaging. Supporters of PET MPI suggest higher diagnostic accuracy when compared to SPECT MPI, especially when Attenuation Correction is not available on the SPECT system.

Cardiac PET imaging must be performed on a PET or PET/CT system as SPECT imaging systems cannot image these higher energy agents. Instead of using readily available unit doses of Thallium or Technetium based MPI agents, Cardiac PET utilizes a Rubidium (Rb 82) Generator or an Ammonia (N-13) cyclotron for onsite production of the patient doses. Rubidium generators and Ammonia cyclotrons require a significant and ongoing investment, so a considerable volume of patients is necessary to support the overhead.

The working assumption is that PET MPI can reduce downstream costs by creating less false positives. While reducing false positives can lower costs, the total expense of providing PET MPI testing is considerable to both the practice and the patient.

Benefits of Cardiac PET

Cardiac PET is an excellent tool to diagnose patients who may have CAD. PET MPI benefits patients with a high likelihood of interventional needs because of its ability to calculate estimated blood flow and flow reserve. For patients who fit this profile, data from a PET MPI scan can be used to gauge the potential success of intervention (angioplasty, CABG, etc).

Images from Cardiac PET cameras typically offer excellent clarity and resolution due to the high-count rates and high Kev level of the PET MPI agents. Additionally, PET systems all have Attenuation Correction (either source based or CT based), further increasing reader confidence when interpreting images.

Though Cardiac PET is a useful tool in diagnosing coronary artery disease, a very small percentage of cardiac practices own a PET imaging system. The most recent estimates suggest less than 200 dedicated Cardiac PET facilities are operational in the U.S.

Drawbacks and Risks of Cardiac PET

One of the limiting factors in the growth of Cardiac PET is the cost of offering the modality. PET systems, whether refurbished, used, or new, are significantly more expensive than SPECT systems in terms of purchase price and in terms of ongoing repair, maintenance, and upkeep.

Outside of the known camera costs, the ongoing expenses and consumables are a considerable jump from SPECT. The nature of the radiotracers requires costly, long-term contracts that must be committed to before the first scan is provided.

For practices and hospital systems with the right panel size, Cardiac PET can be a profit center that offers a real benefit to patients. However, for groups that have clinical volume in the gray area, it can be a financial burden.

Because of this dynamic, it’s essential to know what imaging volume is needed to cover your overhead. While vendors may provide a pro forma, they often minimize cost factors, so the decision requires more due diligence as compared to other modalities.

Additionally, there is growing uncertainty about the future of reimbursement for Cardiac PET scans. Today, Medicare does not require prior authorization or pre-certification in order to be reimbursed for performing PET MPI. This stance on PET reimbursement has driven very modest growth over the last 18 months. Most Medicare Advantage plans currently require the same prior authorization or pre-certification for payment as is mandated by private insurance payers. The scrutiny will undoubtedly increase as study volumes grow. Even a slight change in reimbursements could move the camera from being a profit producer to a financial loss.

The Bottom Line

There is no question that Cardiac PET imaging offers high-quality images, may increase reading confidence for interpreting physicians, and provides information that may prove invaluable for some patients. Current estimates are that between 15% and 25% of MPI studies may be more appropriately performed as PET MPI rather than SPECT MPI (if PET MPI is available).

Even considering possible reimbursement instability, with the right panel size it’s a beneficial modality to add to your diagnostic imaging department. That said, it should be explored with a mindful approach that takes the full cost into account.

Ultimately, you want to perform the right test, for the right patient, at the right time, and for the right reason. Gaining a thorough understanding of the required investment, technology, and reimbursement dynamics is the first step in the process to determine if and how a Cardiologist might add PET MPI to their diagnostic toolkit.

Intraoperative benefits of Ergo touted in the Journal of Pediatric Surgery

Posted on: 03.15.18

The portability of the Digirad Ergo Imaging System is making a significant impact in the pediatric oncology world. The Journal of Pediatric Surgery recently published an article on its intraoperative use. Most notably, it reported on how nuclear imaging with the Ergo effectively reduces the time under anesthesia and offers real-time confirmation of lesion removal. Digirad recently spoke with Dr. Marcus M. Malek of Children’s Hospital of Pittsburgh of UPMC, to further elaborate on the study.

Single environment reduces time under anesthesia

In order to guide lymph node biopsy, pre-surgery lymphatic mapping is done via lymphoscintigraphy. Adults and teens are generally able to tolerate the procedure while awake. It does, however, involve an injection and the need to remain still, which can often be difficult for a child. For that reason, young pediatric patients, and some adults for that matter, are sedated and mapped in the nuclear medicine suite and then transported to the operating room. The additional step takes a considerable amount of time and coordination, which leads to downtime in the OR.

The portability of the Digirad Ergo allows the patient to be anesthetized while they’re in the operating room. Prior to the start of the surgery, the nuclear medicine technologist or physician injects the radiotracer in standard fashion. After the tracer has moved to the area of interest, the Ergo acquires the images needed for the lymphoscintgraphy. Once the sentinel nodes are marked and the area is prepped, the surgery can begin without delay. When the procedure and the surgery are done in one environment, it’s safer for the patient, spares them additional time under anesthesia, and alleviates the need for transport.

Visual confirmation in real-time

Beyond reduced anesthesia time, a camera in the operating room allows the surgeon to confirm the lesion of interest has been removed in real time. Certainly, a preoperative lymphoscintigraphy can help with mapping, but it cannot visually confirm the lesion’s removal. The Ergo allows confirmation of lesion removal or, in some cases, identification of lesions that were thought to be removed or hidden behind another. Visual representation is a fail-safe that ultimately improves surgical outcome.

In the past, some have equated portability with lower quality images, but the Digirad Ergo doesn’t trade one benefit for another. It delivers high-quality images that technologists say rival any static nuclear camera and its compact, portable design offers maximum clinical versatility.

Read the full article, Use of intraoperative nuclear imaging leads to decreased anesthesia time and real-time confirmation of lesion removal , at the Journal of Pediatric Surgery.

Move from HEU to LEU Nearing Completion in the United States

Posted on: 03.08.18

Technetium (Tc-99m), the decay product of molybdenum-99 (Mo-99), is an essential component in cardiac nuclear imaging. In the past, the primary source for this radioisotope was highly enriched uranium (HEU), but market dynamics and legislative action have changed that. The last five years have seen a sustained move to low-enriched uranium (LEU), and the United States is expected to be fully transitioned to LEU by the end of 2018.

The Call for Change

The American Medical Isotope Protection Act of 2011 was enacted to not only promote the domestic production of molybdenum-99, but to replace the role of HEU in the production of medical radioactive isotopes.

Uranium is considered highly enriched when the concentration of the U-235 isotope exceeds 20%. If the proportion of U-235 is less than 20%, it’s categorized as low enriched uranium (LEU).

In an effort to reduce the amount and potential misuse of HEU, the Department of Energy promoted an initiative to reduce the dependence on HEU in the United States. Reactors around the world responded and have been moving toward the conversion from HEU to a process that uses LEU.

What the Move from HEU to LEU Means for Nuclear Imaging

The final product, Tc-99m, remains exactly the same regardless of the source material. There is no difference in the quality or effectiveness – only the raw material processed by the radiopharmacy. Both LEU and HEU approaches result in the same isotope with equivalent performance.

Even though there have been changes in the production process, nuclear medicine providers will not be affected by the shift. The availability of isotopes sourced from LEU generators is steadily increasing as the conversion continues throughout 2018.

U.S. manufacturers who produce Technetium-99 generators, and supply the radiopharmaceutical industry, are in full support of the conversion and are establishing a steady supply of radioisotopes derived from LEU sources. Although some feared that the shift would increase isotope prices, it appears that much of the conversion costs have already been factored in, and no dramatic increases are expected.

Ultimately the move from HEU to LEU will result in a more stable market and reliable supply of Tc-99 which is positive for the entire industry.

A Closer Look at the Digirad X-ACT+ (Infographic)

Posted on: 03.01.18

Download a PDF version of this infographic

Diversified Molybdenum-99 Production Easing Supply Concerns

Posted on: 02.22.18

In recent years, there’s been a heightened focus on the supply of Molybdenum-99, the radioisotope used in nuclear diagnostic imaging. Previous regulatory and capacity issues have caused shipment delays, but today the outlook for molybdenum-99 supply has never been stronger.

Reactors step up production

One unlikely catalyst for the turnaround has been the closing of Canada’s National Research Universal (NRU) reactor in Chalk River, Ont., in 2016. At its closing, Chalk River produced nearly 30% of the world’s supply of molybdenum-99. The nuclear medicine community feared that the shortfall would jeopardize the supply.

Not only did the remaining world reactors in Europe, South Africa, and Australia more than fill the deficit left behind by the closing of Chalk River, an additional three reactors have come online, which has further strengthened the radioactive isotope’s supply.

The more stable supply can also be attributed to diversification. With almost one-third of the world’s supply produced by Chalk River and another significant portion from the High Flux Reactor in the Netherlands, any prolonged breakdown of the remaining worldwide reactors would cause disruption on the supply chain. Now, with the supply diversified across many more reactors, one reactor’s supply issue is less likely to cause a global impact.

Radiopharmacies and diversification

Radiopharmacies are also working smarter and using diversification to their advantage. Maintaining multiple relationships among suppliers allows them to minimize any potential service disruptions. If one reactor source suffers an extended setback, a well-positioned radiopharmacy can leverage the diversity they’ve created in their supply chain to continue providing reliable service and delivery.

In order to hedge against the impact of one reactor’s shortage, it’s critical for nuclear medicine departments, cardiology practices, and other consumers of radiopharmaceuticals to make sure their radiopharmacy partner has a diversified supply chain.

Exclusivity with one supplier may offer the most advantageous pricing. However, diversification opens additional doors and allows you to sidestep a shortage without interruption. In the molybdenum-99 supply chain, each cog in the wheel must run smoothly. When one breaks, those providers who have diversified their sources will be able to adjust while others who have exclusive contracts may not.

If you’re negotiating a radiopharmacy contract, it’s also prudent to protect yourself with a serviceability guarantee. This performance clause will allow you to exit the contract if your supply needs cannot be filled due to lack of diversification.

The future of isotope production

Diversification has proven to help successfully and effectively manage the delicate supply and demand of molybdenum-99. But, as we move forward, the industry is also looking at domestic sources of production that would not only increase availability in the United States, but also alleviate the time and travel challenges that come with crossing international boundaries.

While the supply chain is strong and the industry is continually working to mitigate any potential supply challenges to customers and the marketplace as a whole, there’s always room for improvement. Pursuing domestic production, new methods and improved technologies are sure to positively impact the future of isotope production.

Domestic Supply of Tc-99m Isotope, CMS focuses on Illegal Billing, and more

Posted on: 02.15.18

FDA Clears Path For First Domestic Supply of Tc-99m Isotope

On February 8, 2018, the U.S. Food and Drug Administration (FDA) and the Nuclear Regulatory Commission (NRC) took steps to ensure a stable and secure supply of a critical radioactive imaging product used to detect potentially life-threatening diseases. The FDA approved the RadioGenix System, a unique system for producing Technetium-99m (Tc-99m), the most widely used radioisotope in medical imaging. The NRC is issuing guidance and will license the RadioGenix System to enable the Tc-99m it produces to be used for medical imaging. Continue reading…

CMS Reboots Effort To Curb Illegal Medicare Billing

The CMS is restarting an initiative meant to prevent providers from illegally billing some Medicare beneficiaries for cost-sharing. The agency will start sending new billing notices to providers this summer, alerting them when certain beneficiaries should not be billed for cost-sharing, according to a Feb. 2 notice to clinicians.

The CMS first launched the effort last year after receiving reports that providers hit some patients that were dually eligible for Medicare and Medicaid with coinsurance costs even though they were enrolled in a savings program. Continue reading…

PET-CT Scans For Pancreatic Cancer Patients Eliminates Additional Surgery

A recent guideline from the National Institute for Health and Care Excellence (NICE) in the United Kingdom recommends PET-CT scans should be used to more quickly and accurately diagnosis and manage pancreatic cancer, resulting in a 20 percent reduction in surgery to remove the cancer.

According to a NICE press release, this recommendation will ultimately mean that pancreatic cancer patients whose cancer has spread and is “inoperable” will not need to undergo additional surgery. Additionally, this will also limit the damaging side effects of chemotherapy many pancreatic patients endure for treatment. Continue reading…

An Important Financial Metric Your Practice Should Track

DSO (Days Sales Outstanding) is the number of days it takes to see a patient and get the final payment posted into your billing system. It’s a critical number when it comes to evaluating the overall health of your practice because it determines cash flow, which helps you budget and plan. If you are like most private practices, every penny counts and knowing you will be able to function as a business is very important. If you are one of those providers or administrators that “sort of guesses,” you’re playing with fire.

Do you know your average DSO? Do you know how to calculate it? If you answered “no” to either of these questions, continue reading…

24% Of Ischemic CVD Patients Die or Are Rehospitalized Within 6 Months

Nearly a quarter of patients with chronic ischemic cardiovascular disease are either dead or rehospitalized within six months of their diagnosis, according to a recent report published in theEuropean Journal of Preventive Cardiology.

Lead author Michel Komajda, MD and colleagues launched the Chronic Ischaemic Cardiovascular Disease Pilot Registry, a 2,420-patient strong database spanning 100 hospitals across 10 European countries. Enrolled patients had either stable coronary disease or peripheral artery disease—two of the most common cardiac conditions—and were followed for six months after seeing a health professional about their illnesses. Continue reading…

What’s next after the cancelation of Episode Payment Models

Posted on: 02.08.18

After much debate, countless delays, and requests from providers to have more involvement in the process, CMS has canceled Episode Payment Models and the Cardiac Rehabilitation Incentive Payment Model. While these payment models have been withdrawn, CMS’ focus on value-based care has not changed.

Back to the drawing board

The stated intention of original programs was to create payment models that help improve quality and care coordination while, at the same time, lower spending. The cancellation of Episode Payment Models and the Cardiac Rehabilitation Incentive Payment Model will now offer the CMS greater design and testing flexibility and the opportunity for more provider engagement. According to CMS Administrator Seema Verma, the new voluntary payment bundles are in the works and details will be announced soon.

The original models could have been modified to allow for voluntary participation on the planned January 1, 2018, start date. Still, CMS concluded that the extent of restructuring would not have allowed adequate time for providers to prepare, implement, and comply with the new requirements.

What’s next?

Looking forward, CMS plans to offer more voluntary initiatives, from which providers can choose to participate. Although some strongly believe that significant progress can only be made through mandatory efforts, evidence suggests that participation, and thus change, is positively affected by well-designed voluntary models.

Verma is a strong proponent of the voluntary models. Although she supports efforts around innovation, she’s somewhat skeptical of mandatory models. “We need to make sure we’re not forcing, not mandating individuals to participate in an experiment, a trial that there’s not consent around,” Verma said. The gradual expansion of the models and a smaller scale that allows ample time for evaluation is what will bring about change.

ASNC 2017 Year in Review by Raymond Russell

Posted on: 02.01.18

In 2018 ASNC will be celebrating their 25th anniversary. As the year began, ASNC’s 2017 President, Raymond Russell, wrote an excellent post to Members looking back at the achievements of 2017. Digirad values the role ASNC plays in Nuclear Cardiology, and we look forward to collaborating with ASNC in the new year. Here’s Dr. Russell’s post:

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It is hard to believe that the year is over-it has gone by in a blink of the eye. However, during that eye blink, the members and staff of ASNC have done an incredible amount of work to support the appropriate use of nuclear cardiology that helps improve the care of our patients. I am proud to have been given the honor to represent ASNC as president and work alongside the talented and hard-working individuals that make up ASNC. I would like to share with you the many accomplishments we have achieved in 2017 and my hopes for a healthy, prosperous, and peaceful 2018 for all.

17: Sharing Knowledge with Referring Health Professionals

ASNC continues to be welcomed at forums across the United States where attendees are seeking knowledge and insight to optimize appropriate referrals for cardiovascular imaging to ensure that patients are neither over- or undertreated. At the 50th anniversary conference of the American Academy of Physician Assistants, ACP.17, ASNC launched the Refer Wisely program, hosted an event that drew more than 280 attendees and positioned its booth as a hub for discussion about primary care professionals’ understanding of relevant appropriate use criteria.

16: Making MIPS Manageable

ASNC continues addressing MACRA and the move toward value-based healthcare on multiple fronts. Society volunteers and staff are in constant communication with government officials, advocating for simple, streamlined policies that will actually serve to improve patient care and outcomes. ASNC is developing a suite of tools to ease the challenges imaging professionals will face as new policies are enacted. The ImageGuide Registry has emerged as an unbeatable tool for meeting MACRA’s Merit-based Incentive Payment System (MIPS) requirements and avoiding reimbursement penalties. Enrollment in ImageGuide – now designated by CMS as a Qualified Clinical Data Registry for the fourth consecutive year – gives facilities access to benchmark data that are invaluable for improving the program quality while fulfilling MIPS reporting obligations. ASNC members are invited to enroll their facilities in ImageGuide Registry at no cost. The complimentary webinar, “Fulfill MIPS Requirements with ImageGuide Registry” explains how it works.

15: ASNC Across the Globe

In 2017, ASNC continued to grow its international presence as ASNC co-sponsored educational programs at meetings in Canada, Japan, Mexico, Portugal, Saudi Arabia, and Spain. ASNC members were invited to present at meetings in Argentina, Austria, Brazil, Chile, China, Cuba, Mexico, and Spain. Almost 10% of the ASNC membership’s practice in 64 countries. ASNC and IAEA hosted its first webinar delivered entirely in Spanish “Elaboración de un informe de cardiología nuclear con SPECT o PET,” it featured Erick Alexanderson, MD, and Fernando Mut, MD. 125 physicians and scientists attended the session. ASNC-IAEA also held its first Arabic/English Webinar entitled “Nuclear Cardiology in the Arab World: Challenges and Opportunities”

14: ASNC Secures AUC Program Delay until 2020

ASNC led an advocacy effort composed of multiple physician stakeholder groups calling for indefinite delay of the AUC Program while its value and necessity were evaluated in the context of the Quality Payment Program (QPP). By delaying the program in the Final Rule, CMS is acknowledging that it agrees with commenters that the goals of the QPP are consistent with those of the AUC program. CMS has delayed the effective date of the Appropriate Use Criteria (AUC) Program to Jan. 1, 2020.

13: Achieving New Heights with ASNC Education

ASNC has received the highest level of recognition, Accreditation with Commendation, from the Accreditation Council for Continuing Medical Education (ACCME). Accreditation with Commendation is awarded to CME providers that demonstrate compliance in all aspects of accreditation requirements and for demonstrating exemplary engagement with the environment in support of physician learning and quality improvement. ASNC demonstrated compliance with all 22 of ACCME’s accreditation criteria through a system of reporting for each and all of its 35 to 45 CME activities hosted each year, including live programs, enduring materials, journal CME, manuscript CME review and online learning reaching an average of more than 6,000 physicians annually. ASNC thanks its leaders, Education Committee members and Chair Donna Polk, MD, MPH, FASNC, program directors, Journal of Nuclear Cardiology CME editor and editor in chief, and staff for ensuring excellence in the Society’s educational initiatives.

12: Boosting JNC’s Impact Factor

The impact factor for ASNC’s esteemed Journal of Nuclear Cardiology climbed to its highest point since it was founded 24 years ago, a full point above its 2015 score. JNC now ranks 17th out of 126 current journals, up from the 27th position, in the Radiology, Nuclear Medicine and Medical Imaging category. JNC also jumped several positions in the Cardiac & Cardiovascular Systems category, from 49th to 38th.

11: ASNC in the Heart of America

There were a number of firsts at ASNC2017. ASNC’s annual meeting was held in Kansas City, Mo. for the first time. Physicians from 58 developing countries were able to access select ASNC2017 sessions as part of a livestreaming initiative supported by the International Atomic Energy Agency (IAEA) and ASNC2017 welcomed several new speakers and the Mayor of Kansas City. MOC points were offered for the attending the live annual meeting and the live Board Prep Course for the first time. Focus for last year’s meeting was disease-based sessions and peer networking. Check out ASNC2017 photos. Save the Date for ASNC2018 in San Francisco, Sept. 6-9!

10: Announcing Category III Code for Myocardial Blood Flow

As 2017 drew to a close, ASNC was pleased to announce that a new category III CPT code for Absolute Quantitation of Myocardial Blood Flow in PET would go into effect on Jan. 1, 2018. The new code is 0482T – Absolute quantitation of myocardial blood flow, positron emission tomography, rest and stress. Category III codes are important tools that help to substantiate utilization and clinical efficacy.

9: Improving Imaging in Women

ASNC advanced its mission of optimizing cardiovascular outcomes with two new resources focused on female patients. The latest ASNC consensus statement, “Myocardial Perfusion Imaging in Women for the Evaluation of Stable Ischemic Heart Disease: State-of-the-Evidence and Clinical Recommendations,” outlines themes that support effective imaging in women and has been heralded as an important step toward precision medicine. ASNC also teamed up with MedPage Today to produce “Women with Suspected Ischemic Heart Disease: What Is the Best Diagnostic Approach?”

8: Achieving a Better National Coverage Decision for Cardiac PET

ASNC led a multi-society advocacy effort to remove prerequisite language for cardiac PET coverage in a local coverage policy. ASNC successfully advocated that the local policy should be aligned with the less onerous national coverage policy.

7: Expanding Your Imaging Toolbox with ASNC Practice Points

ASNC members have access to a growing database of Practice Points and other resources designed to help medical professionals select the best tests for each patient. 2017 saw the addition of a new downloadable Practice Point that distills key take-aways from ASNC’s 2016 Stress Protocols and Tracers Guideline. The Practice Point offers a clear, concise outline of indications, action mechanisms, procedural guidance, contraindications and test limitations for exercise stress testing as well as pharmacologic stress testing with adenosine, dipyridamole, dobutamine and regadenoson.

6: Expanding the ImageGuide Registry to Include Echo

ASNC and the American Society of Echocardiography (ASE) announced at ASNC2017, a partnership to develop an ASE Echocardiography Module, ImageGuideEcho™. This new module will allow the registry to support both nuclear cardiology and echocardiography laboratories as well interpreting physicians, technologists and sonographers from both fields. ImageGuide’s Qualified Clinical Data Registry (QCDR) designation from the Centers for Medicare and Medicaid Services combined with these new echocardiography performance measures will increase the registry’s value as a tool for meeting Merit-based Incentive Payment System (MIPS) requirements.

5: Announcing $50K in Research Fellowship Funding

ASNC and the Institute for the Advancement of Nuclear Cardiology (IANC) are inviting early-career nuclear cardiology investigators to apply for $50,000 in research project funding. The IANC Research Fellowship Award was established in 2017 to encourage and support careers in nuclear cardiology research while growing the science of cardiac imaging and advancing the specialty. The competition is open to most trainees, including post-doctoral fellows and junior faculty who intend to pursue academic careers in nuclear cardiology research. Submit your application for a chance to win funding to support your research, or share this opportunity with your colleagues. Please note: All applications must be received at ASNC headquarters by Jan. 31, 2018.

4: Just Starting Out

CareerStarter, a quarterly publication provides helpful tips to physicians starting their careers from those of us who have weathered those early steps. The CareerStarter newsletter has several focus areas: “JumpStart”–articles on key career hurdles, including employment negotiations and contracts. “Tips for FITs” (advice from mid-career ASNC members to help those at earlier phases of their career), “Freebies & Deep Discounts” (current best deals for education, networking and career advancement in nuclear cardiology)

3: Seek and You Shall Find

Continuing to be a resource for young professionals in the field, the nuclear cardiology community now has a new career-advancement tool! The ASNC Career Center, launched this past Fall and is a comprehensive resource for job-seekers and employers. Users will find job postings and will be able to add their own resumes, making it easy for employers and nuclear cardiology professionals to forge connections. Organizations seeking quality candidates are invited to post positions-at the ASNC member discounted rate!

2: 4,300 and Counting

ASNC continued its upward trend of new and returning memberships, achieving its strategic goals and ensuring that cardiovascular patients receive optimal imaging care this year, especially with our early-career/Fellow-In-Training members. There were more than 650 new members who joined ASNC in 2017, making this year’s total number of memberships the highest it’s been in the last 5 years! Thanks to ASNC’s Membership Committee chaired by Randy Thompson, MD, FASNC, and to every one of ASNC’s 4,300+ members for joining in our effort to lead the field and support education, advocacy, quality and professional development. Become an ASNC member

1: ASNC turns 25!

With the arrival of 2018, ASNC marks 25 years of supporting the nuclear cardiology community – its patients, professionals, partners and friends. We’ve launched a year-long celebration of our silver anniversary, so stay tuned for special communications that will highlight past accomplishments, provide access to special resources and opportunities and test your ASNC knowledge!

Raymond Russell, MD, PhD, MASNC
2017 President, ASNC

Is a single-head camera acceptable in today’s market?

Posted on: 01.25.18

As nuclear cardiac imaging technology has evolved, gamma cameras have graduated from single-head to multiple-head detector technology. Although single-head SPECT cameras are not necessarily obsolete, there are an increasing number of drawbacks if you choose to continue using it to diagnose cardiac patients.

Dual-head cameras reduce scan time by half, simply because there are two heads. Each rotation is only 90 degrees compared to a single-head that is responsible for the full 180 degrees. A triple-head camera can complete a scan in about one-third of the time of a single-head camera.

The popularity of Gated SPECT

In years past, higher vs. lower volume dictated the need for a single or dual-head camera. But, as technology evolved, gated SPECT (GSPECT) became state-of-the-art and grew into one of the most frequently performed procedures in nuclear cardiology. The additional combined minutes of scan time needed to gain enough count density was significantly improved with a multi-head camera.

Nuclear medicine is, by all counts, a low statistic science. Anything done to lower the statistic results in an inferior image, and consequently, anything done to increase the statistic improves the image. The goal is to use as little dosing or time as possible to reach the medical diagnosis. By using a multi-head camera, you may increase the total counts per stop, thereby improving the counting statistics with a significantly shorter total scan time and/or lower dose, resulting in a better image.

From the patient’s perspective

Time is not only relative to the procedure and your overall volume, but it’s also important to patients. A higher quality outcome completed in less time leaves the patient with a better overall experience. It also allows them to be more compliant during the scan. A patient who can remain still results in a better image than one from a patient who moves, even if the image is motion corrected. In fact, the correction itself can create artifacts. Consider the practicality, too. When a patient is uncomfortable or in pain, a procedure that finished even five minutes sooner could make a world of difference.

Improving your single-head camera

Over the last decade, advanced reconstruction algorithms, like Digirad’s nSPEED™, have been developed to mathematically improve statistics. Today, if your single-head camera doesn’t include the algorithm, you can invest in a software package, which can increase the speed of the scan time without degrading the image.

While software upgrades can lead to improvements of a single-head camera, a multi-head camera is still faster, includes higher statistics, and results in a better image. You also won’t benefit from all the other advantages should you have chosen to replace your equipment. It simply might not be the best available use of your time, energy, or money.

Upgrading in today’s market

If you upgrade your equipment to a dual or triple-head camera, your advantages are significant.

Today, advanced reconstruction algorithms are standard features, so you’re choosing to improve the image quality in half the time, thereby increasing your lab’s overall efficiency. You’ll also have access to the latest versions of software.

A dual or triple head camera also gives the technologist the flexibility to deliver the very best image. A multi-head camera with an advanced reconstructive algorithm can offer improved image quality and lead to a more confident and accurate diagnosis. Additionally, with tools like Digirad’s TruACQ Count-based Imaging™, each scan is fully personalized to each patient by quickly reading the activity originating from the myocardium prior to the scan, and recommending the appropriate seconds per stop to meet ASNC count density guidelines. This individualized care doesn’t prolong the technologist’s workday because they have the tools to do the best job possible.

Upgrading is not just about how many detector heads your system has. It’s investing in a better and more sophisticated way to deliver nuclear cardiology.

Smart ways to take advantage of the ASNC ImageGuide Registry

Posted on: 01.18.18

Launched in 2015, the ASNC ImageGuide Registry is the first national registry developed to support non-invasive cardiac imaging and reduce the increasing regulatory reporting burden. It effectively promotes and ensures continuous quality improvement for referring physicians, technologists, and laboratories by improving efficiency, elevating the level of patient care, and reducing downstream costs. With equal weight, it was designed with the desire to build a database that spurs new research that will, in turn, grow and expand the nuclear cardiology field.

Why is it important to physicians?

Across the entire healthcare insurance industry, plan payers are continuously moving toward value-based purchasing where cost and quality are major factors that help determine reimbursement levels. Alternative payment models, bundled payments, and higher deductible plans in the commercial insurance market and Medicare’s new quality payment and the MACRA MIPS programs are clear indications of the shift in direction. All lend themselves to physicians practicing within the clinical practice guidelines. The ImageGuide Registry can promote and reinforce the highest quality delivery of care and improve outcomes at an appropriate cost point, which, in turn, can help increase reimbursements.

In addition, the measures, which were created by and for ASNC members, are more meaningful to the nuclear cardiology industry than what would be reported through traditional MIPS measures, another way ASNC has committed to helping physicians achieve appropriate reimbursements and promoting the highest level of excellence in diagnostic imaging.

What are the benefits?

The ImageGuide registry allows physicians to submit data and, based on ASNC reporting guidelines, determine their level of performance. Are they testing the proper patients with the appropriate indications and using the applicable protocols? Are they using dose optimization strategies and returning reports to referring physicians on a timely basis? Physicians, or the practice administrator, can review the data over a given time period and identify areas for improvement.

Given the change in healthcare reform and the increase in out of pocket costs, patients are becoming more savvy. As consumers, they want to make sure they choose a physician that delivers the highest quality service, orders only the appropriate tests, and helps them avoid multiple copayments for unnecessary visits. The registry offers concrete evidence that helps physicians demonstrate the value they provide to patients who are paying more than they have in years passed.

Physicians will be able to use the registry to compare their performance against the 15 different metrics it tracks. And, because CMS has recognized ASNC’s ImageGuide Registry as a Qualified Clinical Data Registry (QCDR), physicians who participate and submit data to the registry will also meet the Physician Quality Reporting System (PQRS) requirements each year.

How do physicians submit data?

Data can be quickly and easily submitted manually through the register’s portal, which takes a speedy 60-90 seconds. If offices are using reporting software, like Sytermed, Cedars-Sinai, or INVIA, they’ll be able to automatically submit their data and bypass the manual entry.

ASNC asks that physicians submit their tests on a regular basis, without any cherry picking of cases. The objective is to review all tests to identify opportunities for improvement. Physicians will be able to view their individual data, but the practice administrator will be able to look a comprehensive report of the entire lab’s performance. Even though it’s physicians who are being tracked, it’s also helpful for the technologists because the registry tracks overall quality. It takes a whole team to improve the quality of service and care, so the reporting applies to the entire lab.

Who should join the ASNC Registry?

The registry is available to any nuclear cardiology lab or physician. In fact, for cardiologists who perform nuclear cardiology, participation in MIPS through ImageGuide is the most cost-efficient and effective method of submitting data. Because the benefit from Medicare applies to total Medicare receivables, and ImageGuide is specific to nuclear cardiology, physicians are able to track their imaging, improve it, and reap the benefits without having to submit as much data. Other registries often require the submission of all patient management.

Practices can be set up in the registry as a cardiac imaging group, a smaller practice, or simply as physicians performing nuclear cardiology. If you’re an ASNC member, the registry is complimentary with your paid membership. If you’re not a current member, the cost is $750 per year, which is still a prudent investment given the potential reduction in Medicare reimbursements it could help avoid.

An easy transition

If you think that participation in the registry will require heavy lifting, it’s quite the opposite. ASNC has support that can help will registration and data submission, initially and ongoing, so it’s not as difficult as one would think. If you’d like to get started, simply visit the ImageGuide portal and begin the enrollment process. If you have questions or need assistance, contact an ASNC representative.

Despite the noise, CMS changes in 2018 will be minimal for Nuclear Medicine

Posted on: 01.11.18

CMS recently released the Physician Fee Schedule final rule for 2018, and after an eventful year, many nuclear cardiologists are wondering what 2018 will bring. While 2017 witnessed extensive changes to CMS rules, MIPS reporting requirements, and the highly-debated QPP final rule, it appears that dramatic changes are not on the horizon for 2018.

A Focus on Quality Improvement

In spite of all the debates, discussions, and general noise, there are no significant changes that will affect nuclear cardiologists in the 2018 rule. Current projections are seeing a 4.5% increase in PET procedures and a minimal increase, nearly static, in nuclear cardiology. Bundled hospital outpatient services and supports also remain the same.

The changes that are slated relate more to the quality initiative. As we’re moving into MIPS, the new reporting requirements will continue to evolve, but now with an expanded list of exclusions. Other revised rules make up the smallest list we’ve seen in years. The 700-page report is a stark departure from the typical 2,000 pages of prior years.

Changes in Private Payers Reimbursment

Generally, the industry seems to be in an acceptance phase, especially on the private payer side. They’ve resigned to the fact that the Affordable Care Act, in one form or another, is here to stay. Providers have seen a dramatic increase in accountable care plans and premiums are on the rise. Coverage is becoming more contracted, and there are more limitations on which services and procedures are covered.

A primary area of concern for Nuclear Medicine centers around private payers tightening restrictions on procedures, who can perform them, and the need for prior approvals. In total, revisions to CMS rules in 2018 appear to be minimal and will hopefully bring additional stability to reimbursement patterns.

Where to get Nuclear Medicine CME credits in 2018

Posted on: 12.21.17

One of the requirements for Intersocietal Accreditation Commission (IAC) or American College of Radiation (ACR) accreditation renewal is the successful completion of 15 continuing medical education (CME) credits per physician and the 15 continuing education units (CEU) per technologist.

It’s important to note that the credits must be specifically relevant to nuclear medicine. This critically important detail is often overlooked and can lead to a practice being cited for non-compliance.

In order to have enough time to complete the appropriate number of courses, it’s essential that physicians and technologists begin the continuing education process early. One CME/CEU is equal to 1 hour, so each staff member should expect to dedicate 15 hours per 3-year accreditation period toward earning these credits.

Some course choices are subject to a registration fee, and others are offered for FREE. Ultimately the courses you choose should be interesting and provide information that will further your education on the subject.

Recommended Courses

Below are four of our preferred classes for earning your Nuclear Cardiology CME credits.

ASNC 2017 Best Practices in Nuclear Cardiology

This on-demand course is comprised of sessions and presentations from the Core Track of the live ASNC2017 22nd Annual Scientific Meeting. The focus is to showcase current best practices when performing nuclear cardiology imaging studies that include strategies for reducing radiation dose and applications of appropriate use criteria in the clinical practice. It offers 13 CME credits to physicians and it expires on October 26, 2018. Cost: Members $250, non-members $350

ASNC 2017: Read with the Experts Track

This on-demand activity is comprised of sessions and presentations from the Read With The Experts Track of the live ASNC2017 22nd Annual Scientific Meeting. The focus is to showcase current best practices and practical solutions to common nuclear cardiology dilemmas when dealing with patients with cardiovascular disease undergoing cardiac imaging studies. It offers 10 CME credits to physicians and it expires on October 26, 2018. Cost: Members $250, non-members $350

Recent Advances in Clinical Nuclear Cardiology and Cardiac CT: State of the Art Updates and 101 Evidence-Based Case Reviews

The objectives of this multimodality imaging course are designed to meet the needs of professionals who perform or request nuclear cardiology, cardiac CT or Cardiac MRI studies. The course emphasizes the use of these modalities across the spectrum of patients routinely seen by physicians for both the evaluation of individuals with suspected or known coronary disease as well as other non-coronary cardiac disease states. Join a faculty of expert cardiac imaging clinicians and scientists from across the country who will guide you through the latest advances in nuclear cardiology, cardiac CT and other imaging modalities. The ACCF designates this live activity for a maximum of 21.75 AMA PRA Category 1 Credits™. Cost: Member $550, non-member $750

Nuclear Cardiology Review: Technical and clinical/radiation safety/regulations

This course is a comprehensive review of radiation physics, better images and interpretation, understanding safety, radiation biology, and tests, procedures, and protocols. It follows the CBNC exam content outline and includes an additional CBNC Board Review Course as an option at no additional charge. It offers 15 CME credits. Cost: $295

Additional Courses

ASNC 2017 Scientific Session Meeting on Demand

This on-demand activity is comprised of sessions and presentations from the live ASNC2017 22nd Annual Scientific Meeting. Cost: Members $599.00, non-members $799.00

Appropriate Use of Myocardial Perfusion Imaging in Women

This is an online video discussion focuses on choosing the appropriate diagnostic cardiac imaging test in women. Cost: FREE

Approach to Known and Potential Ischemic Heart Disease

This session of the live ASNC2017 22nd Annual Scientific Meeting focuses on nuclear cardiology studies for known or potential ischemic heart disease. Cost: Members $75, non-members $125

ASNC Nuclear Cardiology Board Prep 2017 On Demand

This on-demand board prep course delivers 19 hours of education from the live ASNC2017 22nd Annual Scientific Meeting. Cost: Members $1,299.00, non-member $1,399.00.

ASNC 2017: Boot Camp: A Comprehensive Boot Camp for Heart Service Line Administrators, Laboratory Managers, and Nuclear Cardiologists

These sessions focus on practice management topics such as staffing of a nuclear cardiology lab, staff training, economics of coding and billing, and optimal protocols. Cost: Members $75, non-members $125

Isotope Basics

This brief lesson will review some of the basics of nuclear physics. It will concentrate on those principles important in patients undergoing myocardial perfusion imaging. Cost: Free

Sensitivity and Specificity

This tutorial will review the methods for determining the characteristics of a diagnostic test, including sensitivity, specificity, positive predictive value, and negative predictive value. Cost: Free

Baye’s Theorem

Essential to the application of stress testing with nuclear imaging to a patient in your office is the clear understanding of Bayes’ Theorem. Cost: Free

Nuclear Stress Testing to Diagnose CAD

Review the important literature which forms the basis by which we use nuclear perfusion imaging to diagnose CAD. Cost: Free

How to set-up a QPP compliant reporting mechanism

Posted on: 12.14.17

Are you overwhelmed thinking about creating QPP compliant reporting? Well, you’ll be relieved to learn it’s not very different from the way in which you previously reported your data, especially under the Quality category. CMS does require different reporting thresholds and specific information for certain reporting mechanisms, however. You’ll have to capture additional information that was not included, so you’re not totally off the hook.

Quality measures

Under QPP, quality measures account for 60% of the MIPS composite score, so it’s critical to choose and report on the measures that will best fit your practice. Review the quality measures outlined in the MACRA final rule. Select up to six measures and one outcome measure from the approved list of either the individual quality measures for MIPS 2017 reporting or the MIPS 2017 specialty reporting. In doing so, consider what you’ve previously reported for PQRS and the feedback you’ve received. Be careful though that you don’t continue to choose ease of data collection over the value of the score since the importance of the outcome now has a significant impact on your reimbursements. Compare your historical numbers against the benchmarks to gain insight into whether you should keep or replace the measurements in your 2017 reporting.

When it comes to improving performance on a specific measure, you’ll also need to consider the extent to which your existing workflow will need to be improved and the feasibility of implementing and maintaining those modifications. Remember, reporting is required, but your performance in each category is what determines your score. Maximizing your performance and your score is key.

As a rule, all quality measures must be reported in the same manner, so whether that’s Part B claims, EHR, registry, etc., the chosen reporting mechanism will also impact which measures are able to be included.

Advancing care information

The MIPS advancing care information (ACI) category replaces the meaningful use program and accounts for 25% of your MIPS composite score. To meet the requirements of this category, you’ll need an Electronic Health Record (EHR) vendor. If you’re not currently using an EHR product and service, you’ll need to purchase and implement one, but be sure the product you choose is certified. An EHR is certified when it has met the technological capability, functionality, and security requirements required by the Secretary of Health and Human Services and has also received certification by the Office of the National Coordinator (ONC) and CNS. If you already have an EHR vendor, be sure to inquire about their MIPS readiness plan and how they can assist you in your meeting your MIPS objectives.

Four Advancing Care Information measures are required for 2017, and 5 measures each year following. There are 9 additional measures in the Performance Score that are optional and available to earn extra points. With your EHR vendor, it’s critical to discuss the issues of data ownership, commitment to future certification requirements, and public health reporting options. You’ll also need to conduct a security risk analysis each year to ensure the privacy and security of your patients’ health information.

Improvement activities

The Improvement Activities category of MIPS accounts for 15% of the MIPS composite score. It evaluates the degree in which you participate in activities that work to improve your clinical practice. You’ll need to choose from the list of activities in this category and demonstrate your performance in 4 of them over a period of 90 days.

Attesting to improvement activities can be done through your choice of the CMS Quality Payment Program website, a qualified registry or qualified clinical data registry, or your EHR system. This is the simplest form of reporting since you only need to confirm that the activity was completed. You can choose the activities that are most meaningful to your practice since there are no subcategory reporting requirements.

You’ll need to click “Yes” to each activity that meets the 90-day requirement on the CMS Quality Payment Program website or work with your EHR vendor to determine the best way to submit the confirmation of completed activities through a qualified registry, qualified clinical data registry, or EHR.

Regardless of the submission method, the CMS document policy requires you to keep any supporting documentation for 6 years.

Auditing your submitted information

CMS will selectively conduct annual audits to validate data submitted under MIPS, so you should always be prepared for a potential audit. Be sure you’re using EHR templates for your documentation and that they include the required support for each measure. It’s also helpful to keep a record of the patients on whom you report for each measure and the specific time period so they can be easily identified in the case of an audit.

How to reduce False Positives with SPECT MPI imaging

Posted on: 12.07.17

A false positive is an abnormal test result that unnecessarily promotes a patient to the next level of testing. It’s problematic, especially in today’s economic environment, because it places an additional cost burden on patients, the healthcare system, and insurance companies. It also exposes patients to higher risk invasive procedures, additional discomfort, and is ultimately an inefficient use of time.

As the healthcare industry moves closer toward value-based billing, there are even more pressing concerns. Soon the actual number of false positives will impact your facility’s quality scores, which will threaten the level of your reimbursements and affect your bottom line. Today there is significant pressure for medical providers to deliver scans that are of the highest quality. Here are some steps that help can help decrease the chance of a false positive:

Technical quality assessment

Once the prescribed isotope has been injected, it’s critical for the technologist to wait the suggested amount of time for blood pool and bowel clearance prior to imaging. Waiting the correct amount of time allows the technologist to evaluate the existence of any extraneous activity that may interfere with the heart uptake or imaging process. The technologist should also assure the rest images are satisfactory before proceeding to the stress phase of the exam.

Assessing raw data

After the technologist acquires the data, it should be assessed for quality. Motion can significantly impact the quality of a study to the point where the patient may have to be rescanned. While there is software that can perform motion correction, a study that can be checked and action taken while the patient is still present offers the best results.

Acquisition time

Acquisition time should vary by patient based on their specific factors in order to ensure the appropriate count volume for every patient. That’s why the cookie-cutter acquisition protocol isn’t always sufficient. The technologist must be able to accurately calculate the sufficient minimum dose and how long the study should last for each individual patient. The best way to ensure accuracy is with a camera that prompts the technologist with the calculation. Additionally, software like Tru-ACQ™ can automatically calculate the imaging time required on a per-patient basis at the time of imaging regardless of patient size or dose, thus allowing for reductions in imaging time and/or dose.

The impact of new technology

If your camera is ready to be replaced, you may want to consider a camera that is equipped with the tools to help you reduce the number of false positives. The Cardius X-ACT+ not only prompts the technologist at the appropriate quality control checkpoints, but it also includes the Tru-ACQ software package that calculates the appropriate imaging time based on individual patient variables.

Attenuation correction for SPECT MPI is also a major differentiator, providing PET-like diagnostic value. Patients have the potential for normal artifacts or variances simply due to the natural anatomy of the body. Correcting for that with a tissue map is the best way to see through the artifacts that create these false positives. Last but not least, the X-ACT+ is built for patient comfort, which will inevitably decrease the chance of a poor diagnostic study due to motion.

For more information on the Cardius X-ACT+ or any of the Digirad cameras, click here.

Healthcare QuickLinks: Avoiding practice embezzlement, new CMS rules, and more

Posted on: 11.30.17

Healthcare is ever-changing, so it’s important to stay up to date on advancements and issues that may impact the development, operation, maintenance, and growth of your services. Here are some important developments:

Warning signs to look for to avoid practice embezzlement

Theft and embezzlement is widespread, and it occurs more often in healthcare than in most other industries, amounting to $25 billion in annual losses for medical practices, according to the Association of Certified Fraud Examiners. A 2009 survey by the Medical Group Management Association found that an astounding 83% of practice administrators have been associated with a practice where there was employee theft or embezzlement. “It’s happening every single day. People just aren’t catching it and aren’t taking the time to look for it,” says Reed Tinsley, CPA, a Houston-based accountant who specializes in working with physicians and medical practices. Continue reading…

Missed ASNC 2017? We’ve got it for you!

The ASNC 2017 Scientific Session On Demand includes over 53 hours of sessions and presentations from the 22nd Annual Scientific Session of the American Society of Nuclear Cardiology. The focus of the 2017 meeting was to showcase current best practices, new ideas and emerging technology, radiation safety and appropriate use criteria in the nuclear cardiology clinical practice. This year we’ve added video recordings of 10 select sessions and, don’t forget, the session also fulfills 52.25 CME credits. Order now!

New research shows where in the brain the earliest signs of Alzheimer’s occur

Researchers at Lund University in Sweden have for the first time convincingly shown where in the brain the earliest signs of Alzheimer’s occur. The discovery could potentially become significant to future Alzheimer’s research while contributing to improved diagnostics. “A big piece of the puzzle in Alzheimer’s research is now falling into place. We previously did not know where in the brain the earliest stages of the disease could be detected. We now know which parts of the brain are to be studied to eventually explain why the disease occurs”, says Sebastian Palmqvist, associate professor at Lund University and physician at Skåne University Hospital. Continue reading…

CMS releases final OPPS rule for 2018: 8 things to know

CMS has released its final 2018 Medicare Outpatient Prospective Payment System rule, which cuts payments to hospitals under the 340B Drug Pricing Program and authorizes Medicare to reimburse for knee replacement surgeries performed in outpatient facilities. Here are eight things to know about the 1,133-page final rule. Continue reading…

CMS dials back plan to slash payment for off-campus services by half

The CMS finalized its proposal to slash what Medicare pays for healthcare obtained at medical facilities that are owned by hospitals but located off their campuses. The agency released its finalized 2018 physician fee pay rule Thursday, dropping off-campus facilities’ rates from 50% to 40% of what they would have been paid under outpatient rates. Originally, the CMS had proposed to drop the rate to 25%. The smaller reimbursement cut did little to assuage hospitals’ concerns. Continue reading…

New system for treating colorectal cancer can lead to complete cure

Researchers at Memorial Sloan Kettering Cancer Center in New York City and Massachusetts Institute of Technology in Boston have developed a new, three-step system that uses nuclear medicine to target and eliminate colorectal cancer. In this study with a mouse model, researchers achieved a 100-percent cure rate—without any treatment-related toxic effects. The study is reported in the November featured article in The Journal of Nuclear Medicine. Continue reading…

How mobile imaging is changing healthcare in rural areas

Posted on: 11.16.17

Years ago, all hospitals were primarily independent, but recently we’ve seen more consolidation in the healthcare industry. The consolidation has largely been driven by new economic realities, which have pressured hospitals and clinics to band together and create their own partnerships or merge with larger hospital systems, in order to survive.

Patients are being drawn out of smaller communities

Smaller, rural facilities are being significantly impacted by the consolidation trend as well. While creating or joining a larger organization generally results in more money to fund needed improvements and garner greater negotiating power, it may also be unintentionally promoting smaller, rural hospitals as urgent care facilities. One consequence is that patients tend to utilize their services for urgent care, but choose to continue any follow-up care at larger hospitals in nearby cities, and that’s creating a new level of competition.

Traveling outside of the community for all types of services has become less of an inconvenience and more of an accepted practice in today’s society. When a patient thinks about where they’ll receive the best care, a 60-90 minute car ride does not negatively impact their decision.

Many rural hospitals are banding together to form their own associations or networks. Others are independently fighting to hold onto their patients. They’re supplementing their services and employing state-of-the-art shared and mobile solutions that are cost-effective, reliable and customized to meet the facility’s needs.

Critical Access Hospital designation

In an effort to continue and improve the availability of essential healthcare services, and to reduce the financial vulnerability of providing those services to some of the rural communities, the Centers for Medicare and Medicaid Services (CHS) designates some rural hospitals as “Critical Access Hospitals.” Through cost-based Medicare reimbursement, hospitals can true-up their costs at year-end to alleviate any deficit.

Every rural hospital cannot be designated as a Critical Access Hospital, however. There are eligibility requirements and restrictions that generally include:

25 or fewer acute care inpatient beds
35 or more miles between hospitals
average stay of 96 hours or less for acute patients
24/7 emergency care services

Where do we go now?

It’s more important than ever for rural hospitals to offer core services, or even consider expanding the list of core services that they have offered in the past. They may not own the in-house equipment and employ the full-time staff needed to support the community, but that’s no longer a challenge that can’t be overcome. Providers like DMS Health are committed to providing cost-effective options to hospitals and patients through their mobile healthcare services. By helping to alleviate equipment shortages, outdated technology, and understaffed facilities, they are able to work with medical facilities and physician groups to overcome the challenges in order to deliver excellent patient care.

The basics of the Quality Payment Program (QPP) and what it means for your practice

Posted on: 11.09.17

In an effort to move away from fee-for-service payments and put more emphasis on quality of care, CMS unveiled the new Quality Payment Program under The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The program’s goal is to improve reporting and ultimately change the way clinicians are paid for their services under Medicare. Quantity can no longer be the driver when quality is the sacrifice to getting there. The new QPP is a major step in improving care across the entire healthcare system.

Back to basics

Participation in the QPP program is gained through the physician’s choice of one of two pathways: the Merit based Incentive Payment Program (MIPS), which combines the previous PQRS the Value-based Modifier and Meaningful Use programs or the Alternative Payment Model (APM). The path they choose will depend upon their practice size, specialty, location, or patient population. Eligible participants are those clinicians who report Medicare services in the amount of $30,000 and care for 100+ Medicare patients per year.

What does that mean for my practice?

The new program brings a list of tasks for those who prepare to participate. If you’ve determined that your practice is MIPS-eligible, through either a letter received from CMS or by using the CMS MIPS eligibility determination look up tool, you’ll need to implement an action plan that will allow you to submit some or all of your data during the first quarter of 2018—or be subject to a 4% penalty.

Between now and then, you’ll need to review the available performance categories and components, “pick your pace” for participation, identify and implement your reporting mechanism, and finally, review and submit your data before the deadline.

Performance categories: Quality, Advancing Care Information (ACI), and Improvement Activities (IA) are the categories available to describe performance for the 2017 year. It’s important to consider which components will help you successfully reach your 2017 reporting requirements.

Under the Quality category, you’ll need to choose six measures on which to report. You’ll need to have completed 4 activities over a period of 90 days under the Improvement Activities category, and the Advancing Care Information category will require at least five qualifying measures with the option to submit others for additional credit.

“Pick your pace”: During the transition year, you have the ability to “pick your pace,” which allows you to choose whether all, a portion, or none of your data will be reported for 2017. You could have started reporting as early as January 1 or as late as October 2, 2017. If you submit a full year of data for 2017, you may earn a positive payment adjustment. If you submit at least 90 days of data, you may earn a neutral or positive payment adjustment. Even if you submit the minimum amount of data to Medicare, you may still be able to earn a positive payment adjustment. Any payment adjustment is determined by the data submitted, not the length of time it encompasses.

Reporting mechanisms: Will you report as an individual or as a group? Which reporting mechanism will best fit the needs of your practice? Are you working with an EHR vendor? If you’re currently using a vendor, ensure their product will be upgraded to meet your MIPS reporting needs.

What if I miss the October 2nd deadline?

The deadline to begin gathering data to send to Medicare is October 2, 2017. If you’re unable to send the minimum 90-day reporting, your practice will be subject to a 4% penalty.

If your office is MIPS-eligible, it’s critical for you to educate your office staff about MIPS, how performance will be evaluated, and how it will affect your Medicare payments beginning in 2019. Completing your preparation before the October 2nd deadline must be a group effort. When everyone is up-to-date on legislation, is aware of the progress, and understands the repercussions, the process will run much more smoothly.

What to do when your volumes are low and you still own a camera

Posted on: 11.02.17

During the late 1990s and 2000s, many practices chose to purchase a cardiac camera. Reimbursement rates were consistent, testing volumes were high, and from both a patient care and an economic perspective, it made sense to invest in the equipment.

Shortly thereafter, a series of changes in the industry made ownership more challenging. Major insurance companies instituted a cut in nuclear cardiology reimbursements, payers implemented strict imaging pre-authorization requirements, and additional accreditations became required to operate a nuclear lab.

These shifts in the market have made ownership more challenging for physicians that still own their nuclear camera. While many practices may no longer have a loan left on their camera, they still have costs associated with its use, including the licensing, physics consultation, monthly maintenance, isotopes, consumables, and the technologists. The question many doctors have is “What do I do now?”

How are physicians addressing the problem?

Physicians have turned to a number of approaches to address the problem of increased costs and reduced reimbursements. These approaches include:

Staff Changes: Reducing the number of technologists is the obvious and first choice for physicians looking to reduce costs. If you’re seeing a drop in imaging volume, it only makes sense to have the staffing choices be based on that number.

Reduce Imaging Days: If you have a camera sitting in the office it may seem like offering imaging every day makes sense, but that decision can easily drive up costs. Bundling patients and scheduling them for specific days is a way to increase efficiency. Making this move can allow you to make your technologists part-time and keep the existing team vs. letting parts of the team go. Only paying for one or two days a week is much more cost effective if volumes are down.

Negotiating Lower Rates: Some practices have had success with negotiating lower rates on isotopes, consumables, and supplies. Additionally, the cost of the physicist and audits is negotiable so that can be an area to explore. The limiting factor with this method is leverage. Smaller practices that purchase a limited amount of supplies will not get the discount that larger practices may receive.

Partial Outsourcing: Many physicians are turning to outsourcing and bringing in outside vendors to provide elements of the service, particularly around staffing. By not having the full-time employee obligations they can easily scale their expenses to match volume. The quality and the consistency of the technologists are critical here because the team is a reflection of the practice when they’re imaging patients.

The Benefits of Comprehensive Outsourcing

Comprehensive outsourcing is a bigger decision, but it’s one that could result in the greatest cost savings. Under a comprehensive outsourcing arrangement, the outsourcing provider delivers the staff, consumables, accreditation, radiation materials license, etc. Patients are imaged at your office, but the financial burden of operating the nuclear lab is on the outsourcing partner, not your practice. Financially this works because the provider is paid a percentage of the reimbursement, so the upside is much clearer. Image and you earn a profit, don’t image and there is no penalty.

Programs such as Digirad Select provide a nuclear medicine technologist or cardiac stress technician that handles the imaging in your office, with your existing camera. Other package options include equipment, licensing, supplies, pre-authorizations, repair and maintenance, and accreditation.

Comprehensive outsourcing providers, like Digirad, are able to make the numbers work largely due to leverage. By working with thousands of practices across the country, the rates they are charged are lower, and this creates efficiencies that lower costs and increase the quality of the service.

Regardless of the options you choose to implement, it’s important to stay ahead of trends in both technology and the reimbursement landscape. Managing your overhead will protect your ability to help future patients as the market evolves.

Four ways MACRA can hurt your practice

Posted on: 10.26.17

MACRA requirements have many physicians throwing up their hands in frustration. Extensive changes to their reporting and practice structure are creating a scramble to both understand the rules and create systems to comply.

While some are hoping for a legislative fix, the program is in place and here to stay. Ignoring MACRA will only cost your practice time, money, frustration, and will delay the opportunities for benefits that the program allows. Many practices are unsure of exactly what the rule will mean for them so we’ve compiled four different ways that MACRA can hurt your practice.

1. Possibility of lower reimbursements

The incentive-based MACRA program was designed to cut both ways. Practices that comply and show positive results with patient care are eligible for increases in Medicare reimbursements. But, practices which are less careful with compliance, or cannot show positive results with their choice of direction for patient care, will be penalized with a reduction in Medicare reimbursement. Beginning in 2019, your Medicare reimbursement rates will be directly affected by your MACRA compliance and penalties can be as high as 7%.

2. More paperwork and administrative staff

The core of MACRA involves collecting and reporting patient data to CMS. Growing pains will certainly be part of the process as practices adapt to meet the requirements. New systems, new hires, and a new outlook will be needed to create a workflow that includes the digital vision of MACRA. The law has been termed by some as “death by bureaucratic stranglehold” and practices will need to hire new staff dedicated to addressing the paperwork and data collection, or reorganize current staff to meet the requirements.

3. Capital investments

Encouraging practices to embrace new technology is central to MACRA. The collection of data required by the law will require the purchase and introduction of enhanced software systems such as EHR software, Clinical Decision Support software, and online PACS.

4. Public scoring

Another aspect of MACRA will be a scoring system that will be made public. This component will become increasingly significant as the data is aggregated via web services. Non-compliance or low scores could cost referrals and future patients.

The bottom line

Though many practices will take a wait-and-see attitude before adjusting their systems, it will be those who learn, understand and take action with their practices that will be ahead of the game.

How do Mobile Cardiac Telemetry systems work?

Posted on: 10.19.17

Mobile cardiac telemetry (MCT) is a cardiac monitoring method that uses a small portable device to monitors a patient’s cardiac activity. It records the patient’s heartbeat as they run errands, exercise, and sleep. How exactly does it work, though? How is the data captured and what happens if their heart starts beating too fast, or they feel a few palpitations? We’ve put together a summary of what happens when a physician prescribes an MCT monitor:

The setup

When a physician orders an MCT device for a patient, they’ll also register the patient with their cardiac monitoring provider. The patient will either have the electrodes connected while they are in the office, or the MCT device will be delivered to the patient’s home and the patient will connect the electrodes themselves. The process is not difficult and easy to understand instructions accompany the device.

Once the patient is ready, the monitoring system’s office will activate the MCT device. A baseline test will be collected from the patient, and the information will be sent wirelessly across the mobile network. As soon as the test results are successfully received and confirmed, the patient is free to go about their day.

Beat-to-beat analysis

Some MCT systems feature beat-to-beat analysis, which captures every heartbeat that aggregates over a 24-hour period. No data is ever lost, even when the patient wanders out of the network’s range. In that case, the device will store the data until the patient enters back into range. With access to this level of data, physicians are able to make the most accurate and confident diagnosis.

The mobile cardiac telemetry device is also able to record patient-activated or symptomatic tests, where the patient is able to manually push a button and enter the symptoms when they feel them. The device also auto-triggers for bradycardia, tachycardia, pauses, or atrial fibrillation (AFib).

The data collected through the continuous electrocardiogram is being transmitted to the monitoring center and is reviewed by professionally trained staff, who are looking for any abnormalities as they occur.

Reporting heart behavior

Any symptomatic or auto-triggered events are analyzed as they are received by the monitoring center. In addition, the patient’s full disclosure data is reviewed for onsets and offsets of elusive arrhythmias that may not have been felt by the patient, or any other anomalies. They also quantify AFibs and pauses, calculating the percentages of tachycardia, bradycardia, and compiling a comprehensive list of calculations. Once the study is complete, an end of study report is created and sent to the physician.

MCT is one of the most effective methods of cardiac monitoring. The ability to analyze every heartbeat with little interference to the patient’s normal day, and the opportunity to initiate an immediate emergency response as needed, makes it one of the most attractive choices in today’s market. It delivers advantages to both the patient and the physician that can lead to more efficient care.

How is PET/CT different from traditional PET imaging?

Posted on: 10.12.17

Today, most of the Positron Emission Tomography (PET) scanners you find in hospitals, or delivered via mobile imaging, are actually PET/CT cameras. Modern PET/CT scanners combine both PET and Computed Tomography (CT) scans almost simultaneously to provide a greater amount of clinical data to assist in the diagnosis process.

Combining the benefits of PET and CT

A PET/CT scan includes two parts: a PET scan and a CT scan. The CT portion of the scan produces a 3-D image that shows a patient’s anatomy. The PET scan demonstrates function and what’s occurring on a cellular level. The PET scan is unique because it images the radiation emitted from the patient while the CT records anatomical x-rays, showing the same area from another perspective.

The role of attenuation correction

PET/CT scans not only pinpoint localization; they also offer significant help with attenuation correction, a huge advantage. During a CT scan, the system records numbers, called Hounsfield units, which measure the density of the tissue that it travels through. Not only does the CT produce images, but they also have numbers assigned to each individual pixel.

The PET scan measures the level of radiation coming from the patient and compiles information that the system needs to decipher. It uses algorithms and corrections, including the Hounsfield units from the CT scan, and adjusts the images in accordance with the corrected densities for each region.

In the 1990’s or early 2000’s, a PET-only scan would have used a transmission scan for attenuation correction or forgone it completely. Today, however, there is better technology available. Using both CT and PET to cross-check data and corroborate each other is a way to increase confidence and reduce guesswork. It gives significantly more data points to reference in order to determine a diagnosis and treatment plan.

PET/CT is more than just oncology

One of the biggest misconceptions about PET/CT is that its benefits are limited to diagnosing cancer. There are many new uses that are benefiting from PET/CT technology that fall outside of oncology. For example, in neurology, a brain CT or MRI only looks at the structure. The benefit of looking at function through an FDG-PET scan is that a functional change on the cellular level will be seen before a possible structural change. The same can be said for cardiac imaging, epilepsy, Alzheimer’s disease, dementia, infection and inflammation and a host of others. These are areas that could benefit from taking advantage of the advancements in the PET/CT world.

How to reduce your dose with SPECT MPI studies

Posted on: 10.05.17

Advancements in medical imaging technology have revolutionized health care, allowing doctors to more accurately diagnose disease using SPECT for MPI scans. Any time a physician orders an imaging scan, however, there is always concern about the level of radiation exposure.

ASNC and SNMMI are raising the bar with their guidelines, and the industry as a whole is moving toward a low dose standard. What does that mean and how will that change impact your practice? Here are some resources that will help you better understand and adopt a low dose protocol.

Implementing a low-dose protocol (link)

If you are considering the implementation of a low-dose protocol, you’ll need to evaluate three important elements within your practice: proper patient segmentation, commitment, and technology.

Patient Segmentation

Proper patient segmentation is a large part of implementing a low-dose protocol because each patient is a unique combination of age, weight, shape and medical history. Did you know that ASNC estimates half of the patient population falls under the appropriate criteria for low-dose? Following the ASNC guidelines can help physicians decide when to reduce radiation exposure in order to optimize patient care.

Commitment

It only takes one physician to publicly advocate low-dose imaging to get the conversation started. With this progressive thinking, however, your practice will have to collectively adopt a new low-dose culture. The physicians, both referring and reading, must be committed to a low-dose protocol in order to successfully implement the change. It will require further education, training, leadership, discipline and diligence along with a “can-do” attitude from all parties.

Technology

With a low-dose protocol, the goal is to acquire an image with sufficient quality for maintaining diagnostic accuracy. Maintaining image quality while reducing the patient dose is a challenge, but new technology makes it possible. A multi-head camera, combined with nSPEED reconstruction software and Tru-ACQ Count Based Imaging provides fast acquisition times with the lowest appropriate dose.

TruACQ Count Based Imaging™ is the first and only count-based SPECT imaging technique that ensures consistent counts for every patient study, regardless of the patient’s size, weight, or the dose used. The proprietary software is designed to simplify the decision-making process around acquisition time. TruACQ™ takes a quick look at exactly what the detectors are picking up, which accounts for all possible variables, and provides the optimal scan time for the patient being imaged. The result is the highest quality image in the shortest amount of time.

Stress-Only Protocol (link)

Another way to help lower the radiation burden to patients is to adopt a stress-only protocol. Stress-only protocol is the directive by which a medical provider performs a cardiac stress test without the complementary resting scan. Traditionally, both a resting scan and a stress scan are performed on patients, which are then compared to more confidently support a diagnosis. Often, what could potentially be an abnormality in one image is disproved by the other, thereby reducing inaccurate conclusions. It does, however, subject the patient to two radiation doses, sometimes unnecessarily.

Those with a low probability of heart disease, typically younger patients who have limited risk factors, are the ideal candidates to forgo the resting scan and follow the stress-only protocol. Not only does the protocol support the global drive to decrease the radiation burden to patients, it also reduces costs, and saves time.

Easing concerns (link)

The word radiation may stir-up heightened concerns, especially if a patient is having multiple tests performed. How much radiation is considered safe and over what time period? Do some tests bring greater exposure than others? At what point should they become concerned? These are all valid questions. The bottom line is that medical imaging is a safe, painless, and cost-effective way to diagnose and treat disease.

Is there a real risk?

The decision to implement a low-dose protocol is an important step for both you and your patients. Keep in mind that not every patient is required to be low-dose for your practice to be considered a low-dose lab. In the end, it’s about lowering the radiation burden to your patients more than you are now.

Four ways MACRA can help your practice

Posted on: 09.28.17

For the foreseeable future, MACRA requirements are in place and here to stay. While many are scrambling to understand the new rules and perhaps complaining about the changes it brings, one simple fact is clear: ignoring MACRA will directly cost you money.

Conversely though, the program also offers unprecedented opportunities for medical practices. Embrace it, and the benefits the program brings, are yours sooner than later. Although complicated, MACRA does indeed provide means for good news to medical practices. Here are four ways MACRA can help your practice…

1. Elimination of Sustainable Growth Formula

MACRA replaces the payment formula set forth by the Sustainable Growth Rate (SGR) which had been spiraling out of control and considered a dysfunctional mess for physicians. MACRA prevents previously scheduled payment cuts to Medicare recipients, thus the doctors that treat them. With MACRA, the SGR is gone, and the yearly uncertainty surrounding the fix is gone..

2. Potential for greater reimbursement

MACRA’s clearest benefit for physicians is a financial incentive for compliance with the rules. The increase in reimbursement can be up to 5%, and additional modifier incentives are available for the results-driven accountability of patient care. On $500,000 of revenue, that’s an extra $35,000 for the same amount of patient care.

3. Improved patient outcomes

MACRA’s structure is designed to overhaul the entire medical community. The program’s design moves payment from a service-based reimbursement to a “value-based” health care system that rewards outcomes. The requirements within MACRA are expected to result in the more thoughtful selection of tests, more streamlined diagnoses, and ultimately healthier patients.

4. Streamlined systems

While daunting in its infancy, the reporting requirements of MACRA will be addressed through new vendors and technology. Intimidating changes will transition into new systems that offer continuity between providers as well as great strides in the health information exchange (HIE) — a key goal for the program. While it’s rare for a practice to proactively make such a rapid change, modern technology and new reporting tools can bring significant benefit and efficiency to your practice.

New study explores the significant impact of attenuation correction on downstream costs

Posted on: 09.21.17

Attenuation artifacts present a challenge when interpreting SPECT myocardial perfusion imaging (MPI) studies. Advanced technology has been able to significantly improve diagnostic accuracy through attenuation correction. A team of doctors at Hartford Hospital and the University of Connecticut explored the impact of attenuation correction on clinical decision-making and its effect on the cost of downstream testing.

The goal of the research was to determine if the use of attenuation correction reduced the need for downstream cardiac testing and thus decreased the overall cost of care. The findings of the study on the impact of attenuation correction were featured at the ASNC 2016 Annual Meeting conference in Boca Raton, FL.

Gathering data

The researchers questioned referring providers for hospital inpatients and chest pain unit patients who underwent a clinically indicated stress SPECT MPI over a 1-year period. Twenty-three different providers offered the MPI study results of 90 patients with and without attenuation correction. They were communicated via phone in a blinded, randomized manner along with the determination of whether the patient would be discharged or would remain hospitalized, and if any additional cardiac testing would be ordered. The costs for the additional downstream tests were calculated using the 2015 Medicare fee schedule

The results

The use of attenuation correction resulted in sixteen additional normal studies. Without the use of attenuation correction, an additional nine patients would have remained hospitalized at a significant total cost of $16,200. Interpretation without AC resulted in three additional echocardiograms and twelve additional cardiac catheterizations. The average excess cost per patient for downstream testing was a notable $357.

When considering a hospital patient population, the results of the study present a significant opportunity for savings. Based on the study results, a practice performing 2,500 SPECT studies annually would save the healthcare system nearly $600,000 in unnecessary tests and hospitalizations by using Attenuation Correction.

The bottom line

The results of the study demonstrated how the use of attenuation correction with stress SPECT MPI resulted in a significant reduction in downstream cardiac testing, continued hospitalization, and total cost of care.

Regarding diagnostic accuracy and confidence, the research concluded that attenuation correction is a valuable feature when it comes to SPECT MPI studies. It also proved to relieve some of the burden to the healthcare system by avoiding unnecessary costs and improving the efficiency of patient care. From a revenue perspective, hospitals and providers should also consider using their data to improve their quality scores under the new MACRA reporting since they’ll be able to demonstrate how they provide high quality, efficient care supported by technology.

What is the best cardiac monitoring system for a small practice?

Posted on: 09.14.17

Cardiac monitoring systems come in many shapes and sizes. From Holter to telemetry to EKGs, there is a system to meet your needs whether you’re a hospital or a small practice. If you’re seeking to add cardiac monitoring, upgrade your equipment, or change providers, you’ll need to weigh a few key factors and answer some important questions before making a decision.

Payment and Ownership Options

A popular choice for smaller practices is to utilize a service where the monitors are provided without a direct expense and only billed when the equipment is used. Patients are set up with the device and the practice bills the professional component while the cardiac monitoring provider bills the technical component.

Alternately, a lease ownership model has proven to be successful for hospitals and larger facilities. It’s a substantial capital investment, and there are additional staff responsibilities that accompany the lease ownership agreement. It takes staff resources for effective management, so if the lease ownership option runs the risk of becoming a burden, it’s not the best fit for your practice.

Attention, attention!

Another issue you’ll want to consider is the level of service you need from your cardiac monitoring provider. Larger facilities may not need any additional training or extra attention, so a company that services thousands of other practices isn’t a concern for them. However, a smaller practice might want to consider a company that will take the time to set up training, answer questions, respond quickly and makes their account a priority. A smaller service company will offer more personal service, open dialogue when it comes to issues, and greater flexibility in finding solutions. Integrated practices or hospitals are able to manage multiple relationships across different vendors, but a small practice may require a cardiac monitoring provider that delivers a full range of services.

Mix it up

Even if you’re comfortable with a single monitoring method, offering a mix of modalities is a smart recommendation. Begin with what you’ve used historically and work with your service provider to add newer monitoring options into your workflow. One of the most common mistakes practices make when choosing a service provider is falling in love with the newest novelty. Like a shiny new toy, it’s the latest fad with the coolest look, in the prettiest box. Unfortunately, it may not deliver the best diagnostic capabilities and you’re back to square one.

Generally, cardiac monitoring seems to work best when practices that value personal attention work with cardiac monitoring providers who can focus on their needs. Finding a provider that meets your individual needs and makes you a priority is the smart way to make your cardiac monitoring successful.

22nd Annual ASNC Scientific Session Begins September 14

Posted on: 09.07.17

The American Society of Nuclear Cardiology kicks off their 22nd Annual Scientific Session in Kansas City, Missouri. ASNC 2017 will be held from September 14th through the 17th at the beautiful Sheraton Kansas City Hotel at Crown Center.

This year’s highly interactive programming will provide specialized physicians, scientists, technologists, nurses, and many others professionals from around the world with the latest information on nuclear cardiology, its emerging trends and techniques. The specialized curriculum will review cutting edge scientific advances and provide opportunities to learn from the most experienced and well-respected educators in the nuclear cardiology and cardiac imaging industry.

Alongside workshops, lectures, panel discussions, Read with the Experts sessions, and Great Debates, this year’s Scientific Session will also include a lab Boot Camp, which will be critical in helping to strategically position your lab for long-term success, and all-new interactive workstation sessions. In addition, you’ll find an Exhibition Hall packed with the industry’s most advanced technology and quality services.

Digirad is pleased to announce that we will be showcasing the Cardius® X-ACT+ dedicated cardiac SPECT imaging system with Attenuation Correction and debuting information on our Cardiac PET service program at this year’s meeting. Take a minute to stop and visit us at Booth 212. We’d love to see you!

Accountable Care Calls for High-quality Imaging from Nuclear Cardiology – Frost & Sullivan Report

Posted on: 08.29.17

Frost & Sullivan recently published a white paper titled Accountable Care Calls for High-quality Imaging from Nuclear Cardiology that addresses the role payment reform is playing, and how it could potentially affect what constitutes a well-rounded modality and ultimately the best equipment for accountable care.

The paper acknowledges the introduction and planned expansion of new bundled payment structures for complete episodes of care. It also points out that cardiovascular conditions are at the forefront of the payment reform and that any imaging procedures will need to justify their contribution to the care pathway by showing value in the patient outcome.

As a result, physicians’ expectations of nuclear imaging will need to change, whether it’s at the front end or later stages of care. In part, that process will influence the physicians’ and the industry’s acceptance of what constitutes the best nuclear imaging equipment for what is considered accountable care.

Providers will need to strengthen their ability to provide early diagnoses and prognoses, more actionable guidance and risk stratification in their patient care. They’ll also need to be more accessible across the population and provide a more cost-effective solution for their services.

When Frost & Sullivan searched the market for a nuclear camera that could support the needs and satisfy the innovation demands required by the nuclear imaging industry, Digirad’s X-ACT+ was the only solution. As an added bonus, its price point and total cost of ownership were also extremely attractive features.

Download your copy of the Frost & Sullivan White Paper, Accountable Care Calls for High-quality Imaging from Nuclear Cardiology, here.

A Closer Look at Solid-State Gamma Technology (Infographic)

Posted on: 08.24.17

Download the PDF version of this infographic

Understanding your QRUR

Posted on: 08.22.17

CMS’ Quality and Resource Utilization Report can be used to gauge performance in the same way as the Physician Quality Reporting System (PQRS) and the Value-Based Modifier (VBM) programs.

What is the QRUR?

The new Quality and Resource Utilization Report (QRUR) is a report that was developed by CMS to provide cost performance and quality of care feedback to participants and to provide comparisons against national peer benchmarks.

Why is the QRUR important?

In assessing a practice’s individual performance as it relates to cost and quality of care, it can help providers identify opportunities for improvement and help maximize current and future payments.

The individual taxpayer identification number (TIN) performance measures captured in the QRUR are also used in the calculation of the Value Based Payment Modifier, the positive, negative or neutral payment adjustments that are calculated annually. The report will show how your Medicare FFS payments will be adjusted based on your demonstrated cost and quality performance compared to your peers.

When are QRUR’s available?

QRURs are generated mid-year and year-end. The purpose of the mid-year QRUR is to allow participants the opportunity to assess their performance and make any necessary adjustments before year-end. The mid-year QRUR includes only CMS-calculated measures from Medicare claims and does not include any Quality data reported as part of the Physician Quality Reporting System. It is for informational purposes only and will not affect any Medicare FFS payments.

The year-end QRUR, which is available in the fall of the following year, is a comprehensive summary report for the entire reporting period, January through December. It includes the PQRS quality measures as well as the cost performance and quality of care measures calculated by CMS. This information will be used to calculate the positive, negative or neutral adjustment to Medicare FFS payments under the Value-Based Payment Modifier.

How to access your QRUR

QRURs are available for each enrolled TIN. However, they are not automatically delivered to each provider. In order to access your QRUR, one person from your office will need to obtain an Enterprise Identity Management System (EIDM) account with a Security Official role. Once your account is established, visit the CMS Enterprise Portal. CMS also provides a quick reference guide that will help walk you through the process.

How to prep a site before offering mobile CT, PET

Posted on: 08.17.17

Whether it’s used while you upgrade and remodel, to accommodate increased volume, or for disaster recovery, a mobile CT or PET/CT unit might be the ideal solution either on a short-term or long-term basis. Independent of the mobile imaging provider you choose, there is some lead-time needed to prepare your facility for the service from a regulatory standpoint as well as from a site planning position.

Regulatory requirements

Adding a mobile CT unit to your facility requires the x-ray tube to be registered with the state and an annual evaluation performed by a licensed physicist. Some states also require initial acceptance testing be performed by a licensed in-state physicist. Ideally, the mobile provider’s Radiation Safety Officer will coordinate this service. The process could take anywhere from 2 weeks to 3 months, depending upon the state.

In the case of a PET/CT unit, if the mobile company does not currently hold a radioactive materials license in a particular state, a new application must be submitted. While the approval process can take between three and six months, in many states, the company also has the ability to work under reciprocity for a temporary time period until the new application is approved.

When a current radioactive materials license is already in place, only an amendment to include the additional location address and authorized user is needed. An amendment can take one to three months, depending upon the state. As with a dedicated CT unit, the PET/CT x-ray tube must be registered with the state, and an annual physicist evaluation will be performed on both the CT and the PET portion of the scanner.

A memorandum of understanding must also be signed by both the facility and the PET/CT provider. This document outlines the responsibilities of each party and as evidenced by their signatures, their agreement to the assignments. It is required in all states.

Physical site requirements

Choosing a physical site for the mobile unit is an important decision. Space, shielding design, proximity to your building, and occupancy of the surrounding areas are important factors to consider. The recommended support pad for the mobile unit is concrete and is 10’11” x 40’8”; the measurements for the recommended service pad are 21’ x 58’, which will allow full-service access to the unit.

You’ll also need to consider the size and weight of the trailer when deciding on an area. Its overall weight is 57,000+ pounds, and it is 53’ long. The designated area should provide ample space and be able to adequately support the trailer’s weight without concern of shifting or sinking. Asphalt is ideal because it allows for a firm, level surface, but tightly packed gravel is an option, as is grass in some situations.

Power requirements

Another consideration is power to the mobile unit. A single electrical power source, 3/N/PE AC 480V service fused at 150 amperes, is required for operation of a PET/CT system. It should be located within 300 feet of the main power source. A Lockout/Tagout provision in accordance with OSHA Standard 1910.147 is also required.

Telephone and data service requirements

The mobile unit will have three telephone connections. For use at the site, you’ll need to purchase and install one Hubbell all-weather telephone connection. 50’ phone cords are included with the mobile unit, and the unit is also supplied with 2 CAT5 data line connections, along with the required 50’ data connection cables.

Site Planning Guide

These are the major highlights of the planning phase that you’ll need to consider. Once you decide to move forward, many companies will offer a site-planning guide that delivers more detail, including model numbers and requirements specific to their service to ensure smooth delivery, set up, and proper functionality.

MACRA implementation timeline and key dates you should be aware of

Posted on: 08.10.17

While 2017 and 2018 are transition years for the Medicare Access and CHIP Reauthorization Act (MACRA), there are several key dates of which to be aware. Adequately planning and preparation will offer you the best chance of success in 2019 when benchmarks and reporting begin to substantially affect your reimbursements. Here’s a timeline of important dates to keep in mind:

2017

January 1: Start of the 2017 performance year
March 31: 1st snapshot of APM participation list for 2017 performance period
June 20: Last day to register to participate in MIPS for the 2017 performance period
June 30: 2nd snapshot of APM participation list for 2017 performance period
August 31: 3rd snapshot of APM participation list for 2017 performance period
October 2: Last day to begin collecting MIPS data for any group or individual clinicians seeking to report a minimum of one continuous 90-day period for 2017
November 1: Performance benchmarks for the 2018 MIPS performance period announced
Late 2017: Clinicians and groups meeting the 2018 performance year low-volume threshold MIPS exception or non-patient facing status are notified based on their Medicare services provided during the 2017 calendar year

2018

January 1: Start of 2018 performance year
January 2 – March 31: Window for submitting 2017 MIPS and Advanced APM data for 2017
Spring: Final 2018 payment adjustments go into effect for all clinicians and groups under the final year of PQRS, EHR Incentive Program and Value-Based Payment Modifier based on 2016 performance
Estimated July 31: CMS provides 2017 MIPS performance period feedback and 2019 payment adjustment determinations to groups and individual clinicians
July 31 – September 30: Window for requesting a targeted review of a 2019 MIPS payment adjustment determination based on 2017 performance feedback

2019

Spring: First MIPS payment adjustments of +/- 4% based on 2017 performance begin to be factored into Medicare Part B payments. Advanced APM Qualifying Participants will receive a lump sum payment equal to 5% of the estimated aggregate payment amounts for Medicare Part B covered professional services provided during the 2018 calendar year.

Healthcare QuickLinks: MPI imaging in women, proposed 2018 MACRA Proposed Rule, and more

Posted on: 08.03.17

Myocardial perfusion imaging in women for the evaluation of stable ischemic heart disease

This document from the American Society of Nuclear Cardiology represents an updated consensus statement on the evidence base of stress myocardial perfusion imaging (MPI), emphasizing new developments in single-photon emission tomography (SPECT) and positron emission tomography (PET) in the clinical evaluation of women presenting with symptoms of stable ischemic heart disease (SIHD). The clinical evaluation of symptomatic women is challenging due to their varying clinical presentation, clinical risk factor burden, high degree of comorbidity, and increased risk of major ischemic heart disease events. Continue reading…

10 things to know about CMS’ new 2018 MACRA proposed rule

CMS released its proposed 2018 regulatory updates for MACRA’s Quality Payment Program. Officially titled, “CY 2018 Updates to the Quality Payment Program,” the rule includes several key policy updates that would impact providers’ participation in MACRA starting in 2018. And at 1,058 pages in length, for those who have other items atop their summer reading list, here are 10 Things to Know about CMS’ New 2018 MACRA Proposed Rule. Continue reading…

Human enzyme may be key to unraveling Alzheimer’s disease

Neurodegenerative diseases already affect millions of people in the United States and by some estimates, in 30 years, there will be 12 million people in the U.S. living with a neurodegenerative condition. These diseases include Alzheimer’s, Parkinson’s, Lou Gehrig’s disease and Huntington’s disease. Protein aggregates are the hallmark of a number of these neurodegenerative diseases. New research, published in the journal PLOS Biology, examines a human enzyme that unravels these disruptive plaques. Continue reading…

Study: Physicians miss early signs of heart disease more often than they should

New research points to evidence that general practitioners could be putting patients at a higher risk for severe cardiovascular outcomes by missing initial signs and symptoms for heart disease that could lead to an early diagnosis. The research, published online in The Joint Commission Journal on Quality and Patient Safety, was conducted by CRICO Strategies, a research and analysis organization, and the Doctors Company, a medical malpractice insurance company. The study included more than 250 closed medical malpractice cases in which patients alleged that a general medical practitioner in an outpatient setting failed to identify cardiovascular disease. Continue reading…

Novel PET tracer detects small blood clots

Blood clots in veins and arteries can lead to heart attack, stroke, and pulmonary embolism, which are major causes of mortality. In the featured article of The Journal of Nuclear Medicine‘s (JNM) July 2017 issue, German researchers show that targeting GPIIb/IIIa receptors, the key receptor involved in platelet clumping, with a fluorine-18 (18F) labeled ligand is a promising approach for diagnostic imaging. Current imaging modalities rely on structural characteristics, such as vascular flow impairment, and do not address the critical molecular components. Continue reading…

Hospital impact—Providers beware: Performance under MIPS can influence overall patient volume

The Merit-based Incentive Payment System (MIPS) is an attempt by the federal government to characterize in a single score the value of a provider’s care relative to other providers. Though the program is not without its challenges and limitations, it does begin to give consumers some information they need to make informed choices and benefit from competition. The healthcare industry is in the position of having this transparency imposed upon it via federal action because the providers themselves have been slow to tackle true accountability. Continue reading…

Best practices for coding nuclear medicine scans

Posted on: 07.27.17

In recent years, billing for nuclear scans as it relates to coding, has been modified to more accurately reflect the provider services and thus, reimbursement for patient care. We are finding, however, that in internal medicine offices or cardiology groups, where there would likely be fewer conversations about these changes than in a nuclear practice, more clarification may be needed.

Decoding the billing code process

To be clear, the coding itself has not changed, but who can use designated codes have changed. Medicare is very specific as to the way in which they require the submission. The most confusion comes with the series 93015 through 93018 codes. With any test, there’s a differentiation among whether you supply the equipment, supervise the procedure, or interpret the report. Billing for anything other than your specific function, especially when it pays a higher fee, leads to non-compliance and possibly additional scrutiny via an audit. These are typically innocent mistakes that can lead to much larger issues. With that in mind, here is a list of basic codes for billing MPI SPECT that may be helpful:

78452 – Multiple Myocardial Perfusion Imaging, at stress and at rest. This code should only be billed once.

A9500 – The “A” series codes relate to radiopharmaceuticals. A9500 represents Technetium tc-99m sestamibi, diagnostic. This is a per study dose and should be billed for 2 units. If sestamibi is used, bill NDC code 65857-0500-05.

J0153 – The “J” series codes describe drugs. J0153 represents an injection of adenosine – this should be billed 1 unit for each milligram. You might also use J2785, an injection of Lexiscan and should be billed for 4 units.

93015 – This is the global code for cardiovascular stress testing. 93015 should only be used if your practice owns the stress equipment and your physician can interpret the test and issue the report.

93016 – The second in the cardiovascular stress test series, this code should be used if you provide supervision only, without interpretation or report.

93017 – The third in the cardiovascular stress test series, this code should be used if you provide tracing only, without interpretation or report.

93018 – The fourth in the cardiovascular stress test series, this code should be used if you provide interpretation and report only, without supervision.

Using the correct codes is critically important for accurate reimbursement. Knowing which codes to use and why helps increase overall compliance and, above all, properly reflects the procedure that was performed.

What is Fluorescence Attenuation Correction?

Posted on: 07.20.17

Attenuation correction is a process that identifies and corrects for soft tissue artifacts in SPECT images. Ultimately, the goal is to minimize the visual impact of attenuation in order to provide images that more accurately portray the distribution of imaging agent in the patient. This results in higher reading confidence, improves diagnostic accuracy, and lowers the incidence of false positive studies thereby reducing the number of unnecessary diagnostic cardiac catheterizations.

Traditional attenuation correction methods

Historically, there were two primary methods of attenuation correction, line source, and CT. While line source attenuation correction is a valid method and is still currently used, its biggest disadvantages include the challenging number of mechanical failures, the difficulty of use, line source decay yields imaging quality issues as a function of time and has expensive replacement cost. For these reasons, users often opt for an alternative method when it’s time to consider replacing or upgrading equipment.

CT attenuation correction is a popular method primarily used in the radiology and oncology fields where the CT can be used for diagnostic purposes. However, for a dedicated cardiac environment, the high cost of a SPECT-CT system is unsustainable. Additionally, the costs of constructing a shielded room can be greater than the scanner itself.

The lack of viable options for Cardiologists has resulted in patients being without the benefit of attenuation correction. However, Cardiologists who want to offer attenuation correction are leveraging a new, third method – Fluorescence Attenuation Correction.

Fluorescence Attenuation Correction – Low dose and low cost

Fluorescence attenuation correction utilizes a fluorescence X-ray thus allowing for a lower dose and less radiation exposure to the patient. The method is a unique combination of hardware and software technology that allows for the delivery of superior image quality at the lowest possible radiation burden (less than 5 microsieverts).

From a cost standpoint, FAC does not require room shielding and uses the same detectors as the SPECT system. The homogenous pattern of the fluorescence X-ray also contributes significantly to a better, cleaner image and substantially increases diagnostic confidence.

Currently, fluorescence attenuation correction is only available in conjunction with the Digirad X-ACT+ camera. Although attenuation correction is not new to the industry, Digirad’s methodology is able to offer a significant improvement from a reliability, exposure and cost standpoint. The X-ACT+ uses an optimized design to bring benefits of attenuation correction to the cardiac patient, physician, technologist, and facility. The end result is more accurate results, less false positives, and less needless additional testing which means less radiation burden for patients and lower costs to the payer systems.

Circumferential Intravascular Radioluminescence Photoacoustic Imaging (CIRPI) system debuts at SNMMI

Posted on: 07.13.17

Dr. Raiyan Zaman recently spoke at the 2017 SNMMI Annual Meeting in Denver, Colorado about a revolutionary system that will dramatically improve the early clinical diagnosis and treatment of coronary artery disease (CAD).

The idea that launched the CIRPI System

The Circumferential Intravascular Radioluminescence Photoacoustic Imaging (CIRPI) system is the result of an idea that Dr. Zaman jotted down on a scrap piece of paper one evening so she wouldn’t forget about it in the morning. Thinking about her research, she wondered about the composition of atherosclerotic plaques, which she hadn’t entertained before and considered adding a photo echo-stick to her current work on characterizing vulnerable plaque. That one idea could significantly change the way CAD is assessed and treated. It could also help prolong the lives of a wide number of people by helping to manage their heart disease well before they experience additional, more advanced symptoms.

What is the CIRPI System?

The system includes a unique optic-based probe that combines circumferential radioluminescence imaging (CRI) and photoacoustic tomography (PAT). Not only is it able to locate plaque, but it’s also able to differentiate between stable and vulnerable plaque and determine its composition. Physicians will be able to more accurately assess the clinical situation and decide on the appropriate course of treatment for the patient based on this information.

Currently, there is no imaging modality clinically available that can detect any early stage of vulnerable plaque buildup, including angiography, which can only be used in the advanced stages of plaque detection. It’s unique because it gives the interventional cardiologist substantially more diagnostic information.

When will the CIRPI System be available?

The CIRPI System is still being tested and is expected to move to clinical trials soon. Dr. Zaman estimates that the CIRPI System pilot study should be up and running within three years. In fact, there are already several cardiologists who are looking forward to enrolling several of their patients.

Dr. Zaman’s late night wondering was what won an NIH K99/R00 award that funded her research and eventually led to what may be the most effective method in the treatment and risk management of CAD. We’ll be following her progress and will be excited to report on any updates.

Healthcare QuickLinks: The ambulatory approach, CMS Bundled Payment Rules, and more

Posted on: 07.06.17

The ambulatory approach

There is no disputing the move toward outpatient procedures in the invasive cardiac procedural space. Percutaneous coronary intervention (PCI) shifted from 365,788 inpatient procedures in 2004 to 201,142 inpatient procedures in 2014. This dramatic change represents a 45% decrease in inpatient procedures. Similar numbers can be seen in the electrophysiology service line; from 2004 to 2014, inpatient pacemaker implantations decreased by 49%. According to the Physician/Supplier Procedure Summary report, 2014 was the first year that physicians were paid by Medicare for more outpatient than inpatient invasive cardiology procedures. Continue reading…

CMS issues final rule to delay some bundled payment models

The Centers for Medicare & Medicaid Services (CMS) has finalized a rule to delay the implementation of some bundled payment models. The final rule, posted to the Federal Register on May 19, 2017, pushes back the expansion of the Comprehensive Care for Joint Replacement (CJR) Model, the Cardiac Rehabilitation Incentive Payment Model and the care coordination models. CMS proposed the delay at the end of March. The rule pushes back the effective date for the Cardiac Rehabilitation model and some provisions of the care coordination model from July 1, 2017 to January 1, 2018. Continue reading…

Incorporating population health in next gen of bundled payments

The next generation of bundled payments should focus on population health management, researchers recently argued in a Journal of the American Medical Association report. The authors from the Corporal Michael J. Cresencz VA Medical Center, Perelman School of Medicine, Massachusetts General Hospital, and Leonard Davis Institute of Health Economics pointed out that existing bundled payment models suffer from several limitations. The alternative payment model is based on a fee-for-service payment structure and they incent providers to select the healthiest patients for care to avoid high healthcare costs. Continue reading…

Management of type 2 diabetes in 2017

More than 29 million people in the United States and 420 million globally have diabetes, with a projected global prevalence of 642 million by 2040. This accelerating pandemic comes with high personal and financial costs to the individual, society, and the economy. The expanding number of antihyperglycemic medication options for type 2 diabetes, often involving different mechanisms of action and safety profiles, can be a challenge for clinicians, and the increasing complexity of diabetes management requires a well-informed strategy for prevention and treatment of this disease. Continue reading…

SNMMI partnering with NDSC to disseminate appropriate use criteria

Clinicians referring patients for imaging with nuclear and molecular modalities will soon be able to do so with ready access to utilization assistance that’s based on appropriate-use criteria developed by the Society of Nuclear Medicine and Molecular Imaging (SNMMI). That’s because the group is working with National Decision Support Company (NDSC) to put the criteria in front of these referrers, as long as they use NDSC’s widely adopted Care Select Imaging platform, according to a news release sent by NDSC. Continue reading…

Regulatory Requirements: The impact on cardiac imaging and dose management

In recent years, radiation dose management awareness has heightened across the healthcare industry to address growing concerns around the consequences of too much exposure, and a lack of standardization around dose management protocols and practices. Industry stakeholders have responded by introducing new regulations and requirements for healthcare providers, including the CMS recent MACRA ruling along with updated Joint Commission standards which call for more stringent dose management and reimbursement requirements. Understanding exactly what prompted these changes is paramount for health systems around the world to ensure compliance and success in this evolving environment. Continue reading…

Myocardial perfusion imaging in women for the evaluation of stable ischemic heart disease—state-of-the-evidence and clinical recommendations

What are the PQRS requirements?

Posted on: 06.29.17

The Medicare Access and Chip Reauthorization Act of 2015 (MACRA) repealed the flawed Sustainable Growth Rate (SGR) reimbursement formula and replaced it with the new value-based reimbursement system called the Quality Payment Program (QPP). The program includes the choice between two major tracks: The Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APMs).

QPP and its effect on PQRS

The Quality Payment Program essentially adopted the quality measures and reporting methods from the Physician Quality Reporting System (PQRS) and Value-Based Modifier (VBM) programs. Although there are some changes to the PQRS reporting methods, the quality reporting methods are effectively the same. The new system defines four different categories of performance, which contribute to the annual MIPS final score that ultimately determines the negative or positive adjustment to the physician’s payment.

The revised reporting structure is touted to be less burdensome than the previous PQRS. The number of measures was reduced from nine to six, and none of those measures are required to be chosen from the National Quality Strategy domain. The performance period was also shortened by more than nine months.

Do you meet the eligibility requirements?

MIPS will grow to include most healthcare professionals who bill for Medicare Part B, but depending upon the performance year, you’ll gradually be drawn into the reporting group. Initially, it’ll expand it’s coverage over the first few years:

2017 and 2018: Includes physicians, physician assistants, clinical nurse specialists, and certified registered nurse anesthetists.
2019 and beyond: It will also include physical and occupational therapists, speech-language pathologists, audiologists, nurse midwives, clinical social workers, clinical psychologists, and dietitians/nutritional professionals.

Are you exempt from the eligibility requirements?

There are some providers who may meet the eligibility requirements, but for one reason or another, are exempt from MIPS. For the 2017 performance year, there are three exemptions:

Clinicians who are in their first year of Medicare Part B participation
Clinicians billing Medicare Part B up to $30,000 in allowed charges or providing care for up to 100 Part B patients in one year
Clinicians in entities sufficiently participating in an Advanced APM

What are the data submission requirements?

One of the objectives of the Quality Payment Program is to consolidate all of the MIPS performance data submissions into one single efficient transmission. In order to support this effort, MIPS is expanding its current PQRS quality reporting methods, such as registry, EHR, and QCDR, to allow for reporting measures across the MIPS categories of Quality, Advanced Care Information, and Improvement Activities.

Key requirements for a mobile CT provider

Posted on: 06.22.17

Most hospitals offer CT imaging services in-house, but there are times when bringing in a mobile imaging service on a provisional basis makes more sense. Whether you’re remodeling your CT imaging space, your equipment requires repairs, or you need help managing a backlog, provisional imaging can be a smart decision.

Vendors become an extension of your hospital

One of the most important things to keep in mind, however, is that any vendor you partner with becomes an extension of your hospital. Your patients should not be able to make any distinction between the level of service delivered by the hospital staff and the mobile imaging staff. The cleanliness of the environment, the detailed protocols, and the quality of the equipment should be the same, ensuring the patient’s positive experience follows through to the mobile service. What qualities help demonstrate and reinforce a commitment to upholding your high standards? Here’s a list of requirements to look for in a quality CT mobile imaging provider:

Equipment

Mobile providers should provide equipment that is currently and widely used in the market. While a 64-slice CT scanner might be preferable, a 16-slice camera is an excellent fit for most studies and provides image quality with high throughput. You’ll also want to ensure that the CT scanners are XR-29 compliant as non-compliance can adversely impact your reimbursement.

An OEM Service Agreement

To safeguard against downtime, a mobile provider should have an OEM Service Agreement. This ensures that factory-trained service engineers are performing preventative maintenance on a regular basis and that they’ll have access to OEM parts.

JCAHO Certification

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is an independent group that administers voluntary accreditation programs for hospitals and other healthcare organizations. They develop performance standards that address elements of operation, such as patient care, medication safety, infection control and consumer rights. Your mobile provider should be JCAHO certified, which implies that they have a superior level of quality standards and processes in place.

HIPAA Compliance

The mobile provider staff should be just as committed to protecting patient privacy and abiding by all healthcare regulations set forth by HIPAA as your hospital staff. Be sure they have an active and ongoing HIPAA training program in place.

A Hygiene Program

Many healthcare workers say hygiene is the most important tool in preventing the spread of healthcare-associated infections among patients. Be sure the mobile provider has strict policies and procedures around hygiene and they educate their staff on the critical importance of infection control.

When you’re looking for a mobile provider, high quality and excellence come at a premium. If a hospital truly desires the patient experience to carry through to that mobile asset, they have to look to vendors that are committed to providing that same level of superior quality, patient-centric service.

What is MIPS?

Posted on: 06.15.17

The Merit-Based Incentive Payment System (MIPS) is the highly anticipated replacement for the flawed Sustainable Growth Rate (SGR) program. Slated to begin in 2019, the new payment system will negatively and positively adjust individual payments based on provider performance and ultimately demand the highest quality of patient care from healthcare professionals.

How does your performance compare?

A mean performance score of all MIPS-eligible professionals during a given time period will establish a benchmark score. Each participating physician will then receive a combined performance score of 0-100, based on their individual performance in each of the four categories:

Quality (30 points): PQRS, EHR MU, and Qualified Clinical Data Registries (QCDRs)
Resource use (30 points): VBM and episodes of care
EHR Meaningful Use (25 points): EHR Meaningful Use
Clinical practice improvement (15 points): Credit for clinical practice improvement activities such as MOC Part IV and QCDRs.

By comparison, scores that fall above the benchmark will receive a positive payment adjustment and those that fall below the benchmark will receive a negative adjustment.

The scores and their corresponding adjustments will remain in effect for one year and will not necessarily impact next year’s adjustment. On a positive note, however, credit can be given for improvement from year to year as well as for achievement.

Negative and positive adjustments

Under the MIPS program, positive payment adjustments can be up to 4% in 2019 and grow to a maximum of 9% in 2022 and beyond. Depending upon the number of high versus low performing professionals, these percentages can be adjusted to keep the budget balanced. However, even if all physicians meet the MIPS threshold, there is a special Additional Incentive Payment per year that ensures funds for positive updates.

The maximum negative adjustment will be applied for scores that fall between 0 and ¼ of the threshold and professionals with scores closer to the threshold will receive proportionally smaller negative payment adjustments. Negative adjustments will be capped at 4% in 2019, 5% in 2020, 7% in 2021, and 9% in 2022 and beyond. Professionals whose performance score is equal to the threshold will not receive any adjustment.

MIPS will apply to most all professionals with the exception of providers in rural areas, certain specialties and those participating in Advance Payment Models (APMs).

Three approaches to offering imaging services at a satellite office

Posted on: 06.08.17

Opening a satellite office is an excellent way for cardiologists to expand their reach within a community and grow their patient base. But what level of services should you be offering at the satellite offices? Imaging is often one of these question marks. Sure, it would be great to provide full ultrasound and nuclear imaging services, but equipment and staffing for diagnostic imaging require a sizable capital investment. Knowing the options will help you minimize the pitfalls and position yourself for the best chance of success. We’ve identified three options that practices take when considering how to offer imaging at satellite locations. These approaches include the Hub & Spoke, Mobile First, and All-in. Let’s take a look at each one in detail.

Hub & Spoke Approach

The concept of the Hub & Spoke approach is to limit your capital risk by simply not offering imaging at the satellite office. That may sound simplistic, but many times cardiologists take a “wait and see” approach to satellite offices and are unwilling to invest in any equipment or imaging staff until the location proves itself as viable.

Using this method, these offices are designed to create imaging referrals and not straight diagnostic imaging revenue for the satellite. No nuclear imaging equipment is located in the office and patients who need additional testing are directed to the central office. The glaring drawback is that this works against the two key features that satellite offices offer. First, you are only offering patient convenience for office visits. If a patient chooses the office because of where it’s located, you may see attrition if they have to drive 15+ minutes for their imaging needs. With a patient travel time of 30+ minutes for diagnostic testing, the failure rate is high in terms of capture rate. Second, you are presenting to the referring physician community that you are not fully committed to provide your full list of services to them and their patients. Referring physicians may stick with existing referral patterns if they feel their patients will be inconvenienced. This also limits the opportunity for the physicians assigned to the satellite office to fully connect and engage with the local referral base. Although the financial outlay of the Hub & Spoke approach is minimal, the capture rate for diagnostics is significantly compromised. This fact will limit the overall success of the satellite office concept.

Mobile-First Approach

The reason many physicians hedge when considering imaging at a satellite is that it does involve risk and a higher amount of capital. Because of this, some practices choose to use a “Mobile First” approach to offering imaging at a satellite office.

With a Mobile First methodology, clinics opt for providing imaging on a limited basis (one or two days a week) scalable to the clinical needs. Simply schedule all patients who need the services on the same day. Some practices choose to move staff and equipment from the main office to the satellite office for the imaging days. Another alternative is to utilize a mobile imaging company to handle all the imaging.

The intent with this approach is to use the resources you already have available until you can gauge patient volume, referral patterns and general success of the office. Either of these options would give you the time and realistic, concrete feedback about the likelihood of financial success and eventually the grounds to solidify your long-term plans for your satellite office.

All-in Approach

The All-in approach involves investing in everything needed to run what is essentially a smaller-scale main office. The office is staffed & equipped for in-office imaging, and patients are imaged five days a week. While this approach sounds like a recipe for success, it brings with it more risk than the other approaches. It requires a significant financial investment, and the actual volume might not match expectations.

However, many physicians who currently offer nuclear imaging choose this route with varying levels of success. Having been through the process before, and having a base of knowledge to build from, allows them to have a better grasp of what it takes to get the department running, how to scale and what is required for financial success.

What is right for your practice?

There is no “right” way to offer imaging services at a satellite office, and the approach you choose should be the best fit for your practice and your patients. Your experience, the location of the satellite, and your local market all factor into the decision, but finding the right balance of risk vs. reward will help your satellite succeed.

Two primary types of Mobile Diagnostic Imaging for Hospitals

Posted on: 06.01.17

Hospitals choose mobile diagnostic imaging for a variety of different reasons, from lack of space to increased volume or remodeling of their radiology facility. There are many different types and styles of mobile imaging so it’s critical to know your options and the different paths you can take if you’re thinking about traveling down this road. Let’s start with the two categories of mobile imaging, provisional and mobile.

Provisional

Provisional mobile imaging is typically utilized by hospitals that are experiencing a temporary disruption or short-term need for CT, PET, PET/CT, Nuclear and various other modalities. Often, facilities that choose this option are already providing these services but are using provisional imaging as a way to maintain their current volume while they either remodel, replace or repair their current equipment.

With provisional mobile imaging, the equipment is delivered to the hospital via a tractor trailer. The trailer is set-up and stays in place for the entire duration of the project, typically 3 to 6 months. It can, however, extend to over a year, depending on the circumstances. Under this arrangement, the hospital will often provide their own staff, but the mobile provider can often offer staffing as well.

Mobile

Mobile imaging services include a scheduled visit from a provider, who also transports the equipment back and forth to your location. This arrangement is ideal if the hospital does not offer a particular imaging modality or if volumes are especially low. Low volumes make owning the system a financial challenge, and mobile imaging is an ideal way to meet your patients’ needs without making a significant investment.

Typically the mobile provider will visit your facility on a consistent pre-determined day of the week and any patient appointments for applicable diagnostic imaging are made for that same day. Usually the mobile imaging provider supplies everything necessary to perform clinical studies including the equipment, patient consumables, and clinical staff. They operate as an extension of the hospital, which allows the facility to remove the overhead, space requirement, and staffing costs. A critical key to your facility’s success in this type of program is to work with an imaging service provider that is accredited, and has formal HIPAA processes as well as a formal compliance and regulatory program.

Hospital requirements

If you are planning to offer mobile imaging at your facility, there are some initial requirements that need to be in place. The area where the mobile unit will be located will require a concrete pad, which must be poured and set-up before offering the service. Power and data must be brought to the area, so it’s important to plan for the connections prior to the mobile unit’s arrival. Lastly, many of the mobile providers require a patient lift so patients in wheelchairs or those with mobility issues can be accommodated.

What is MACRA?

Posted on: 05.25.17

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law on April 16, 2015. It was designed to incorporate the approximately 20 “doc fixes” to the 1997 Balanced Budget Act’s flawed Sustainable Growth Rate (SGR) payment system.

Repealing the SGR provision

Most notably, MACRA repealed the controversial SGR payment system, a fee for service reimbursement model that would have significantly reduced physician salaries, and replaced it with a two-track payment system, the Quality Payment Program (QPP), that will be tied to performance. It will significantly impact the way physicians and healthcare providers are paid under Part B of the Medicare Program.

The delivery of quality and effective care will be major components when it comes to determining reimbursement rates for physicians. More emphasis will be placed on value, as opposed to volume under the current system, and physician performance will be evaluated against specifically determined measures. Payments will increase or decrease based on the outcome and level of provider care.

Consolidated Reporting

Under MACRA, the Merit-based Incentive Payment System (MIPS) will consolidate three existing quality-reporting programs: the Physician Quality Reporting System (PQRS), the Value-based Payment Modifier (VBPM) and meaningful use (MU). It will also add a new performance category called improvement activities (IA). Physicians will be scored on each of the four categories: quality, resource use, advancing care information and clinical practice improvement activities. Their score, which will total 0 – 100, will determine the physician’s payment adjustment.

What else will MACRA do?

Not only does MACRA address new payment structures, but it also includes funding for necessary technical assistance to providers and for Quality Measure Development. It will enable new programs and create strict requirements for critical and accurate data sharing.

MACRA will substantially impact the healthcare system as it works to provide better care, smarter spending, and healthier patients by focusing on physician incentives, superior care delivery, and comprehensive information sharing.

SNMMI Annual Meeting – Show Preview

Posted on: 05.17.17

Have you registered for the 2017 Society of Nuclear and Molecular Imaging (SNMMI) Annual Meeting? You won’t want to miss the most highly anticipated, educational, scientific, research and networking event in nuclear medicine, especially since it’s being held in beautiful Denver, Colorado.

Mark your calendar for June 10-14, 2017, when you’ll join your colleagues in the Mile High City. The Annual Meeting will host over 5,600 attendees including molecular imaging and nuclear medicine physicians, radiologists, cardiologists, pharmacists, scientists, lab professionals, and technologists. They’ll be representing the world’s top medical and academic institutions from 60+ countries around the globe.

This year’s meeting will deliver a comprehensive assessment of the current and future direction of nuclear medicine and molecular imaging from both a research and clinical perspective. It will also provide an in-depth view of the latest technologies and will showcase more than 160 of the top nuclear medicine and molecular imaging products and service providers, including Digirad.

Visit Digirad at Booth 717!

We’re proud to be exhibiting the Ergo, X-ACT+, and QuantumCam at the 2017 SNMMI Annual Meeting. You can find us at Booth 717 so be sure to stop by and see us!

How mobile Women’s health facilities are changing the hospital landscape

Posted on: 05.11.17

Patients are expecting better service from physicians and hospitals. Compounded by the new quality measures that are heavily weighted on patient experience, hospitals are recognizing the need to make changes. If patients don’t report a positive, comfortable or reassuring experience, then providers’ quality scores decline, and it negatively affects reimbursement payments.

What’s changing?

The patient experience is a combination of both environment and equipment. A 2015 study of veteran women reported that environmental elements were critical to having a positive experience. At the same time, quality and current technology should be a standard expectation.

Environments

In women’s health facilities, substantial modernizations are being made. Many are looking at how their women’s healthcare environments can improve both quality and environmental criteria so that they meet the public and private sectors’ expectations.

Larger hospitals are renovating their space, but it’s an expensive undertaking. You’re also seeing it in the design of new mobile units, too. There is much more emphasis and attention on creating a more feminine environment, particularly through color palettes, tone, texture, and lighting. The goal is to have the female population feel more comfortable and relaxed. Ultimately, the traditional clinic setting is not as appealing to women during a mammography or gynecological exam.

Equipment

Today, in terms of equipment, the biggest debate is 2-D versus 3-D and whether the additional expense is worth it. The trend is creating a lot of interesting discussion. Equipment, in general, is a factor that contributes to the overall patient experience.

It’s difficult, though, for hospitals to continue to chase the newest trend or the next modality, especially when a new and improved version of your cutting edge technology is likely already in the works. Smaller hospitals are getting out of the business for just that reason. They’re choosing to use a mobile service in order to avoid the risk of not being able to provide the most positive experience for their patients.

In addition, many don’t have enough volume to dictate spending money on the newest technology. It simply doesn’t make sense to have a mammography unit at the hospital. It does make sense, however, for a mobile unit to be at their location once a week that can provide both components to create a positive experience.

Could a mobile service help your hospital?

While renovation might be the right choice for some, using a modernized mobile service unit could be the smart choice for others, especially when it comes to women’s health. From helping large hospitals with high capacity issues, to serving the smaller hospital communities with access to state-of-the-art equipment, the added value they provide could help raise your patients’ positive experience level and ultimately your provider quality scores.

QuickLinks: MIPS, PET Radiotracer design, bone scan guidelines, and more…

Posted on: 05.09.17

Docs risk reputation damage by reporting minimal MIPS data

This year, physicians can avoid a payment penalty in the Medicare Quality Payment Program by simply submitting a minimal amount of data. But that small amount of data could cause a bigger problem in 2019. In the first year of the program, under the Medicare Access and CHIP Reauthorization Act (MACRA), physicians can ease their way into the program requirements. Under MACRA’s Merit-based Incentive Payment System (MIPS), physicians can submit as little as one quality measure improvement activity for any time period in 2017 and avoid a financial penalty. The more data they submit, the more potential to earn a payment incentive. Continue reading…

Read with the experts: Molecular brain imaging of dementia

On Monday June 12, 2017, at the Society of Nuclear Medicine and Molecular Imaging Annual Meeting, Brain Imaging Council will sponsor a CE Session entitled Molecular Brain Imaging of Dementia. Upon completion, participants will be able to: 1. Examine brain PET and SPECT findings typically seen in Alzheimer’s disease, frontotemporal dementia, dementia with Lewy bodies, and other types of dementia. 2. Use different brain imaging modalities for dementia workup. 3. Describe new imaging methods. Continue reading…

PET radiotracer design for monitoring targeted immunotherapy

In an article published in the April issue of The Journal of Nuclear Medicine, researchers at Stanford University in California provide a template for assessing new positron emission tomography (PET) radiotracers that can accurately identify molecules in cancer cells that prevent the immune system from attacking the cancer. A drug that blocks a cancer’s inhibitory checkpoint molecules is called an immune checkpoint inhibitor and this form of immunotherapy has emerged as a promising cancer treatment approach. However, the lack of imaging tools to assess immune checkpoint expression has been a major barrier to predicting and monitoring response to a clinical checkpoint blockade. Continue reading…

Recommendations on the echocardiographic assessment of aortic valve stenosis

Since detailed recommendations for the echocardiographic assessment of valve stenosis were published in 2009, numerous new studies on aortic stenosis have been published with particular new insights. This document focuses in particular on the optimization of left ventricular outflow tract assessment, low flow, low gradient aortic stenosis with preserved ejection fraction, a new classification of aortic stenosis by gradient, flow and ejection fraction, and a grading algorithm for an integrated and stepwise approach of aortic stenosis assessment in clinical practice. Continue reading…

Top hospital CEO concerns: Outpatient care access, innovative ways to cut costs

Hospital executives are looking for innovative ways to control costs at the same time that they grow service lines to remain competitive in a consumer-driven world. A new survey from The Advisory Board indicates that the top concerns of hospital and health system C-suite executives are to improve patients’ access to care in ambulatory or outpatient settings and also find innovative ways to reduce expenses. The survey, conducted between December 2016 and January 2017, asked 180 executives about their level of concern about 26 topics, ranging from preparing for the Medicare Access and CHIP Reauthorization Act (MACRA) to non-merger partnership and affiliation models. Their top five concerns were: Continue reading…

New guidelines establish bone scan appropriate use criteria for prostate, breast cancer

New guidelines are out for appropriate use of bone scintigraphy, scans for bone metastases. On April 6, the Society of Nuclear Medicine & Molecular Imaging (SNMMI) published appropriate use criteria for implementation with patients who have breast or prostate cancer. The guidelines are designed to help referring physicians and other ordering professionals abide by the requirements set forth in the 2014 Protecting Access to Medicine Act (PAMA). According to the guidelines bone scintigraphy is appropriate for prostate cancer. Continue reading…

Meet the new X-ACT+

Posted on: 05.04.17

Digirad is proud to introduce the new Cardius X-ACT+ Imaging System. We’ve taken the X-ACT camera and completely redesigned it to offer more patient-centric features and deliver significant benefits while reducing the cost burden to the healthcare system.

Technology

The X-ACT+ is the only SPECT/FAC MPI system that features a combination of solid state detectors, rapid imaging detector geometry, low dose fluorescence x-ray attenuation correction, advanced 3D-OSEM reconstruction techniques, and TruACQ Count Based Imaging™.  It offers high definition, high efficiency, unparalleled clinical accuracy—all while lowering the patient’s radiation dose.

Ergonomics

In addition to the state-of-the-art technology, many of the camera’s improvements focused on patient ergonomics. For example, the system is closer to the floor, includes handrails, and the seat placement has been modernized. The system’s new design is not only more comfortable, it’s easier and safer to access for all types of patients. The X-ACT+ ultimately improved upon Digirad’s patient-friendly, open, and upright design.

X-ACT+ also positions the patient perfectly for cardio-centric imaging. The heart never leaves the field of view and images are free of truncation or attenuation artifacts. The X-ACT+ produces images with superior clinical accuracy and provides a positive imaging experience overall.

Digirad Cardius X-ACT+

Looking for an upgrade?

The X-ACT+ is unique because of its combined design, technology, and superior imaging quality. If you’re ready to upgrade your imaging services, the X-ACT+ is the only improvement you’ll need to make.

Practical ways to make your Ultrasound Lab more efficient

Posted on: 04.27.17

Experiencing a deficit or a surplus of valuable time between procedures is all too common for most ultrasound labs. Both of these factors impact the overall efficiency and profitability of the practice. The problem can be traced back to either the practice or the patient and their role in managing the appointment process.

Communicating the details

Communicating and understanding how in-depth and time-consuming a particular test is are significant factors when ordering studies. It’s critical for physicians and schedulers to communicate specifics about the patient, including what the procedure is and how long it will take. Many times a test is scheduled for a 15-minute slot when the unique situation for that patient will require 45-minutes. One failure to communicate can cause delays for the duration of the day and unnecessary frustration among patients and staff.

Details that should be communicated are whether the patient is ambulatory, not feeling well, in pain, or additional factors that may lengthen the time of the appointment. It’s helpful for the scheduler to have a complete reference list of procedures, a description of what it entails, and the standard time slot needed.

Helping patients improve efficiency

When a patient is scheduled for a procedure, they need to be provided any necessary prep information, in writing, so they’re able to comply on the day of the test. They also need to understand the importance of following the instructions. For instance, if a patient is instructed not to eat or drink at least 4 hours before the procedure and they accidentally drink a cup of coffee, the test will need to be rescheduled. This annoys the patient, wastes valuable lab and technician time, and fills a future appointment that could have been used by another patient.

To avoid no-shows and last-minute cancellations, patients should be called or texted appointment reminders 48 hours before their scheduled appointment. They should have the option to respond directly to the call or text with whether they will keep the appointment or if they need to reschedule.

On the day of the procedure, the office staff should be able to deliver expectations that were previously set. For example, a patient should not sit in a waiting room for two hours when they were led to believe it was going to be a 15-minute wait. That’s not to say that the lab could not be having a bad day. A machine may be unexpectedly in need of repair, or the lab may be short staffed. To alleviate frustrated patients, a good plan of action is to call patients an hour before their test time to let them know the lab is running behind schedule.

Another option is to keep a white board in the waiting room that updates patients on the current time delay so they can use it as a reference point. Even better? Consider a texting system that allows patients to leave the office during a considerable wait period and receive a text message closer to the time they are expected back.

Honest communication increases satisfaction

By effectively communicating with patients, you’re keeping them as happy as possible instead of letting them stew in your waiting room. Nothing runs like clockwork, but these are some things that you can do to increase patient satisfaction and help your practice run more smoothly.

NC Today: Kathy Flood outlines the highlights of this year’s program

Posted on: 04.21.17

This year, the American Society of Nuclear Cardiology will host its 2017 NC Today: Best Practices for Today, Innovations for Tomorrow program from April 20 through April 23, 2017 at the Chicago O’Hare Hotel in Rosemont, Illinois.

“This meeting is very different from our annual meeting in that we really focus on the topics that are particularly relevant and helpful to our attendees in everyday practice. It is designed with the goal that they will be able to expand and improve what they are currently doing in practice and take some ‘aha’ moments back to their nuclear lab, and start implementing new and practical processes right away,” said Kathy Flood, CEO of ASNC.

Cardiologists, nuclear medicine physicians, nuclear technologists, radiologists, and other nuclear cardiology professionals from the U.S. and globally will join us for the highly anticipated, case-based training that will ultimately support the nuclear lab team in today’s rapidly changing healthcare environment.

Meeting highlights

Given this value-based era of healthcare, the meeting will address the need and solutions to improve the quality of SPECT and PET imaging so that nuclear cardiology is viewed as a high-value test. It will look at applications that will help manage various conditions, such as heart failure, through image-guided management and explore other strategies and novel applications that will move beyond what’s considered to be within the traditional scope of nuclear cardiology.

Another area of focus will be helping attendees navigate through the barrage of health policy issues. Are you still not sure what MACRA looks like or how your practice will work successfully under the new rules? Hear how MACRA and CV bundled payments impact imaging services and what the future of nuclear imaging looks like as a result.

ASNC, in conjunction with MedAxiom, will once again be releasing the ASNC-MEDEXCELLENCE Survey. These practice trends will serve as a resource to drive performance and create value in your practice. Attendees are able to see what needs to change in order to be in better alignment with best practice labs and ultimately operating at their highest value.

“The program will be filled with valuable education and discussion, but I think the biggest takeaway will likely be the Practical Dilemmas in Nuclear Cardiology session,” said Flood. These are the everyday questions or issues that may or may not be addressed in the guidelines. You’ll hear what the experts do in practice to tackle those not-so-easy situations that you see in your office on a regular basis.

For technologists only

If you’re a technologist attending the event, be sure to check out the pre-meeting session specifically designed to address value in your laboratory. “We want physicians and technologists to come together for this kind of education, because it takes a team to execute,” said Flood, “but we also want to offer time where they’re able to have an exchange among themselves.”

Key speakers

Past ASNC Board members Dennis A. Calnon, MD, and David A. Wolinsky, MD are co-directors of this year’s event. Among others, Jim Udelson, MD and Kim Williams, MD, Chiefs of Cardiology at their respective institutions, as well as past ASNC Presidents, will be speaking at the meeting. Both Rob Pagnanelli, CNMT and April Mann, CNMT will share their technologists’ perspective as well. Each one is an expert in their field and brings a wealth of knowledge to the program. The environment is designed to encourage questions and discussion, so don’t hesitate to join the conversation.

Come visit us!

Digirad is proud to be among the exhibitors at this year’s program so be sure to look for us in the Exhibit Hall. For more information on the program, visit the ASNC website.

Three reasons hospitals use provisional CT, MRI, or PET Imaging

Posted on: 04.20.17

Most hospitals offer CT, MRI, and PET imaging services in-house, but there are times when bringing in a mobile imaging service on a provisional basis makes more sense.

What is provisional imaging?

In traditional mobile imaging, a technologist visits the hospital or clinic on a weekly basis and transports the equipment back and forth with each visit. With provisional imaging, the equipment is left at the facility for a longer period of time, typically three to six months or more. Hospitals may choose this service option for a number of reasons:

1. Remodeling the CT imaging space or purchasing a new camera

One of the most common reasons a facility may choose provisional mobile imaging is in the case of new equipment or a space remodeling project. The remodeling process requires careful planning so as not to interrupt your current service. In the best-case scenario, your service may be inoperative for a few weeks due to construction, and any unforeseen delays could potentially add to that timeline.

Planning ahead and having a provisional mobile imaging service in place is a simple way to avoid inconvenient and costly disruptions. Be sure to start the process early in order to increase the likelihood that you’ll be able to secure the ideal system and configuration for your needs.

2. Long term CT machine repairs

Another popular reason to utilize provisional service is lengthy equipment repairs. When a CT, MRI, or PET imaging system is in need of extensive repairs, a hospital cannot simply stop imaging. Sometimes repairs may only take a day or two, but there are other instances when repairs are significant and can require significantly more time to fix. Waiting on ordered parts or an available service engineer can leave you down for weeks. In this case, utilizing a provisional service is a way to fill the gap while your equipment is brought back online.

3. Bring down a backlog

Lastly, there are times when hospitals simply face a backlog of imaging needs. Regardless of the reason, if volume increases and your current equipment and number of technologists cannot effectively manage the workload, you’re faced with determining the best method of working through the challenge. Bringing in a CT, MRI, or PET imaging system on a provisional basis is not only a way to get out from under the backlog, but it’s also a smart way to determine if this is a trend that needs to be addressed with a more permanent solution.

A Preview of ASNC’s NC Today Conference

Posted on: 04.18.17

The American Society of Nuclear Cardiology (ASNC) will hold its highly anticipated 2017 NC Today meeting from April 20 – April 23, 2017 at the Lowe’s Chicago O’Hare Hotel in Rosemont, Illinois. The Best Practices for Today, Innovations for Tomorrow program will draw cardiologists, nuclear medicine physicians, nuclear technologists, radiologists, and other nuclear cardiology professionals from all over the world who are interested in in-depth, case-based training that will and help them lead their teams in today’s rapidly evolving healthcare environment.

Why Should I Attend?

With healthcare’s growing emphasis on value, whether it’s on how quality care will be assessed or how reimbursements will be calculated, you’ll dive into a comprehensive curriculum that combines practical learning with forward-looking discussions about increasing the value of imaging in practice.

You’ll not only gain knowledge, but also competence and improved performance in areas like reducing radiation doses and applying appropriate use criteria and guidelines. You’ll delve into the evolving role of multi-modality imaging and the technical aspects of PET imaging, and discuss the importance of data reporting and performance measures. In the end you’ll see how these topics and more are contributing to the changing healthcare environment and impacting nuclear cardiology. For more detailed descriptions of the sessions, here’s the program agenda.

Continuing Education

The program content qualifies for continuing education (CE) credit. With scheduling challenges, additional cost, and sometimes limited availability of qualifying instruction, satisfying the requirements of the regulatory world is particularly important for both technologists and physicians, especially in light of the new regulatory mandates.

ASNC is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education (CME) for physicians and designates the program for a maximum of 19 AMA PRA Category 1 Credits. They are also a recognized provider of continuing education credit for technologists. Their CE credit is accepted by the NMTCB and ARRT. The program has been approved for a maximum of 19.0 ARRT Category A credits for technologists.

Visit us!

Digirad is proud to be among the exhibitors at this year’s program. Be sure to look for us in the Exhibit Hall. For more information on the program or to register, visit the ASNC website .

QuickLinks: Physician revenue streams, congressional updates, and medical isotope updates

Posted on: 04.13.17

Physicians should rethink their revenue streams

Ancillary services can boost practice revenue and be a major convenience for patients, but regulatory challenges and competition from hospitals and other players mean that physicians need to think more strategically than ever about their service menu. Payers are increasingly steering physicians to large third-party facilities for traditional ancillaries such as lab work as the insurers chase economies of scale. Regulations limiting the types of providers who can offer certain services, along with increasing competition overall also threaten margins for these ancillary businesses. Continue reading…

Many with irregular heartbeat not on meds they need: study

Many people with an irregular heartbeat who suffer a stroke may not have been on medications that might have prevented their stroke, a new study suggests. Duke University researchers found that 84 percent of stroke patients with the heart condition known as atrial fibrillation (AF) had not been getting adequate clot-preventing therapy. Dr. David Wilber, a cardiologist at Loyola University Medical Center in Illinois, called the findings “sobering.” Continue reading…

Fainting guidelines instruct physicians to search for heart conditions

A set of guidelines on how fainting could be a sign of a serious heart condition was recently issued by the American College of Cardiology, American Heart Association and the Heart Rhythm Society. The guidelines, which are the first of their kind on the topic, can help physicians decide whether fainting is being caused by a heart condition. About 14 percent of Americans have recurrent fainting, according to the guidelines. Continue reading…

MedPAC issues March report to Congress: 8 takeaways

The Medicare Payment Advisory Commission has released its March 2017 report on Medicare payment policy to Congress, which includes recommendations to slash payment rates for home health agencies and inpatient rehabilitation facilities. For a list of the eight takeaways from MedPAC’s March report, continue reading…

Download the 2nd issue of the SNMMI Annual Meeting Preview Magazine

Take a sneak peek into the SNMMI 2017 Annual Meeting. In the latest issue, learn more about optional pre-meeting seminars of clinical, scientific and academic interest taking place in Denver! Plus, view session highlights, including content focused on addressing current professional challenges, and great networking opportunities to see and be seen this June 10-14! Download your copy today.

University of Missouri research reactor files for NRC approval to start U.S. production of medical isotopes

The University of Missouri Research Reactor and its partners Nordion, a business of Sterigenics International, and General Atomics (GA), announce that MURR’s License Amendment Request (LAR) has been submitted to the U.S. Nuclear Regulatory Commission (NRC). This marks a critical step towards implementing domestic U.S. production of molybdenum-99 (Mo-99). Once operational, production from this facility will be capable of supporting nearly half of U.S. demand for Mo-99, which currently must be imported from outside North America. Continue reading…

How does the QuantumCam rate as a general purpose nuclear camera?

Posted on: 04.06.17

For hospitals or healthcare systems with limited imaging equipment budgets or with limited space, a general purpose nuclear camera is a critical component of their service offering. Because of this, finding the highest quality and most versatile general purpose nuclear medicine camera is a top priority.

The QuantumCam is a dual detector, variable angle, total body, SPECT and general purpose nuclear medicine camera. As the most lightweight and smallest camera of its kind, it offers a large field-of-view and delivers all the flexibility you would expect from a dual head, variable angle camera.

Full range of imaging modalities

QuantumCam has the ability to perform the full range of nuclear medicine procedures including total body scans, bone SPECTs, planar imaging, and cardiac SPECT imaging. With its highly flexible detector positioning, and open gantry, non-claustrophobic design, it allows for greater patient comfort and ease-of-use. In fact, the camera’s physical design makes it substantially easier to perform tighter upright or supine lung scans and allows for brain SPECT imaging, among others.

Ultra Small Footprint

The incredibly small footprint is one of the QuantumCam’s biggest advantages. The camera can fit in a 10’x10’ exam room. The size of the camera along with the flexible open gantry design allows for a variety of unique opportunities to image while the patient is confined to a bed, stretcher, or wheelchair . The camera’s flexibility and size are better for patients and allows hospitals to get more from a single camera.

Why choose a general purpose camera?

When evaluating imaging systems, in particular for those intended for a small or mid-sized hospital, one of the most important considerations is its versatility. While a general purpose camera may not be able to match the unique features of a specialty camera, they can perform the widest range of nuclear studies. Coupled with its small footprint and remarkable flexibility, the QuantumCam is a reliable option for providers seeking versatility.

Should I buy a nuclear camera or use a mobile service?

Posted on: 03.30.17

The choice between purchasing a nuclear camera or using a mobile service is an important decision for your practice. There is a broad range of factors that shape the decision, and following a “cookie cutter” formula is not recommended. Understanding the unique dynamics at work in your practice can shed light on which choice is best for you and your patients. Let’s explore some key data points to review:

Study volume

Study volume is an important metric when considering purchasing a nuclear camera vs. contracting with a mobile provider. On the low end, 60 studies per month could technically support camera ownership, but a monthly average of 120 is a more sustainable number. Below 100 studies per month becomes financially challenging and requires temporary staffing and other hybrid approaches to make the best of things. Another way to evaluate the volume question is on the number of days in the week in which you scan. Practices that prefer imaging less studies per day and more days per week will find a need for creativity in managing their non-equipment costs in order to achieve reasonable profitability from their Nuclear Lab.

Established practice vs. start-up

Often, your prior experience can be a contributing factor in the decision. If you’ve owned a camera in the past and understand the requirements, it’s easier to know if ownership is a right fit. If you are starting up a practice, you could initially opt for a mobile service to get a better feel for your study volume before making a major purchasing decision. Given all of the various start-up expenses, including needing cash in the bank to fund the lag between your open day and cash flow back from the various payors, whether or not you want to tie up cash or credit resources for a major purchase is a critical decision point. Physicians who open a smaller 1 to 4 provider practice, versus a multi-physician practice, often choose mobile services over ownership for the similar reasons.

The value of the unknown

One major factor that complicates the decision is clarity on the actual cost burden or potential profitability when purchasing a camera. Because mobile services typically use per-day or other similar billing options, your financial risk is very low, and the practice has a very clear understanding of profit overall, and per day of service. Since camera costs (lease payment or depreciation plus repair and maintenance) are not the highest cost drivers, thinking that ownership is more profitable than a service is not a given. With pending insurance reimbursement changes, new payment models on the horizon, and the reality of appropriate use criteria, it’s difficult to know the exact financial return you can achieve from a camera purchase.

The question of how to provide imaging services touches on a full spectrum of factors including revenue, profitability, patient convenience, market perception, practice size, and patient satisfaction. The final decision is shaped by your study volume and how established your patient base is, but ultimately it comes down to how comfortable you are with the requirements of running a nuclear lab and your willingness to invest the time and energy into managing on your own.

Diagnosing Syncope: Event monitors vs. MCT

Posted on: 03.23.17

Syncope, also known as fainting, is a temporary loss of consciousness and is characterized by its quick onset and short duration. Although the majority of people can say they’ve passed out at least once in their lives, it can also be a sign of a more serious condition.

Diagnosing Syncope: Event monitors vs. MCT

In an attempt to diagnose unexplained syncope, physicians will typically choose to prescribe either an event monitor or an MCT monitor. Both have the ability to record a symptomatic episode as well as automatically trigger a non-symptomatic episode recording if the patient’s heart rate is too fast, too slow, pauses too long or is beating irregularly. The added value of MCT, however, is the beat-to-beat analysis.

What is beat-to-beat analysis?

Beat-to-beat analysis allows the physician to monitor every heartbeat over the entire period of time in which the patient is wearing the device. They are not only able to see the activity that led to syncope, but are also able to see any rhythms that could have potentially led the patient down that path, but didn’t.

The information a physician gleans from MCT’s beat-to-beat analysis can be what changes the clinical outcome for the patient. The event may fall into the “normal” category, but now you’ll be able to expand on why it happened and can help to show the patient the circumstances around the normal fluctuation. The analysis may also help determine if there’s an action to be taken. With an event monitor, you might not have the opportunity to consider these options because the information would not be available. In addition, there is no dependence upon whether an algorithm is working properly with MCT. It delivers the data with 100% certainty because it’s collecting every single beat around the clock.

The flexibility of MCT

When a patient visits your office with an issue, you want to order the most appropriate, cost-effective test. While we know that identifying elusive syncope symptoms is not its primary function, the beat-to-beat analysis of MCT is a substantial benefit to the cause. It can alleviate additional and unnecessary future testing and quickly and confidently identify the issue at hand.

QuickLinks: Outpatient centers, amyloid scans, PQRS and more

Posted on: 03.16.17

Outpatient centers reflect growing health care trend

The outpatient centers that have opened in the past two years at the Long Ridge Health and Science center reflect an ongoing migration of medical services from hospitals to smaller facilities closer to homes and workplaces. And the investment in the outpatient model continues to accelerate, as patients and medical professionals have embraced the evolution. “This is patient driven,” said Dr. Mary Cooper senior vice president of clinical services at the Connecticut Hospital Association. “All of us want the availability of high-quality care that’s convenient. None of us want to spend time away from families, jobs and other commitments by being an inpatient in the hospital.” Continue reading…

Patients ‘relieved’ by amyloid scans

Most patients said they were “relieved” by the results of their amyloid scans, but there’s still room for education as to what those results actually mean, researchers found in a small study. In a single-center study at a tertiary care center staffed with experienced dementia specialists, the majority of 20 patient-caregiver pairs undergoing amyloid PET imaging said they felt relief from the scans, whether they were positive or negative, Joshua Grill, PhD, of the University of California Irvine, and colleagues reported. But several participants thought the scan provided a “definitive” diagnosis, and could reveal information about the severity of the disease, when it can do neither of those things, the researchers noted. Continue reading…

Physician quality reporting system (PQRS)

The Physician Quality Reporting System (PQRS) is a reporting program of the Centers for Medicare and Medicaid Services (CMS). It gives eligible professionals (EPs) the opportunity to assess the quality of care they are providing to their patients, helping to ensure that patients get the right care at the right time. By reporting PQRS quality measures, providers also can quantify how often they are meeting a particular quality metric. Using the feedback report provided by CMS, EPs can compare their performance on a given measure with their peers.Continue reading…

Six thoughts on the movement from inpatient to outpatient care & 7 core thoughts on great leadership

The movement to outpatient care has been gradual. It has been generally at a clip of 2 to 3 percent a year. This movement from hospital inpatient to outpatient varies significantly. Some states have seen very little movement while others have seen substantial movement. Regardless, this movement is expected to continue for several more years. Big box stores saw gradual movement to e-commerce that didn’t immediately kill their margins and business. However, hospitals, like big box stores, have low profit margins and the gradual loss of inpatient to outpatient business ultimately has a very dramatic impact. Thus, even though gradual, at some point, it creeps up on margins and profits and can be very significant. Continue reading…

Here is the key to maintain a thriving practice

Healthcare is unique in the limits physicians have to predict practice revenue from a variety of payer models. As we look to the future of healthcare delivery, medical practices will still contend with these limitations, but they can control at least two things: how well they care for patients and how efficiently they run their practices. On the business side, efficiency can be measured and improved by the right key performance indicators (KPIs). Continue reading…

100 things to know about Medicare reimbursement | 2017

Since its launch in 1965, Medicare has been one of the most influential programs for hospitals, health systems and other providers. Medicare has played a prominent part in various reform movements, including the shift from fee-for-service to value-based payment models, and the program’s policies and reimbursement rates have acted as a catalyst for change nationwide. This article sheds some much-needed light on several facets of Medicare reimbursement, covering everything from the latest update to the Inpatient Prospective Payment System to mandatory bundled payment models. Continue reading…

Five factors that are changing healthcare in 2017

One thing is certain this year—it will be one of unprecedented change for the healthcare industry. With President Trump’s inauguration in January, and his pledge to repeal and replace the Affordable Care Act, everyone is curious what the year will hold. I’ve reviewed all of the predictions and prognostication for what 2017’s top trends will be, and identified what I consider the five factors that will drive the most change in healthcare—in 2017 and beyond. Continue reading…

How to know if mobile CT is right for your hospital

Posted on: 03.09.17

High-volume medical practices and hospitals typically allocate space for procedures including PET and CT imaging systems. The decision to assign valuable space is warranted by the high number of procedures they schedule each day. For smaller practices and lower-volume rural hospitals, however, the decision is not as straightforward. Here are three factors that shape the decision to either purchase and staff in-house equipment or use a mobile service:

1. Capital Constraints

Like most equipment, PET and CT imaging systems are expensive, so you need to determine the best, most cost-effective approach to providing this service to your patients. When evaluating options to purchase an imaging system, ask yourself whether your facility is able to afford the capital costs of this equipment. And if so, will you be able to recoup the capital outlay in a reasonable time period?

Beyond the obvious costs of the cameras, you’ll also need to factor in the additional expenditures required to house the equipment. These include the cost of the staff to operate and manage the equipment. Consider the cost of the service contracts that will help keep the equipment operating accurately, and the cost of the necessary sundry pharmaceuticals.

A second option is utilizing a mobile imaging service. You can compare the rates for renting the equipment and hiring the service, which includes staffing, management, equipment servicing, and all require supplies.

2. Space Limitations

Space is another factor that requires consideration. Does your facility have the space needed for in-house equipment? If you choose to purchase an imaging system, what’s the cost of the real estate you’re allocating to house the equipment? Be sure to evaluate whether it’s the highest and best use for the space. If your facility is “landlocked,” a mobile service that can occupy parking lot space might be more practical.

3. Volume

The decision to purchase or rent a CT or PET camera depends heavily on testing volume; if there are too few patients it will cost the hospital a tremendous amount of money. If there is any question concerning volume, using a mobile imaging service is a way to better match the supply with the demand. It will allow your practice to offer an important service to your patients while eliminating the long-term commitment and responsibility of making a large investment. Mobile imaging can be provided on a long-term or short-term basis with limited or extended operating hours to accommodate the needs of your patients.

Each hospital is different

Committing to the purchase of in-house CT or PET equipment can be a big decision for a smaller hospital or medical practice. While it may be a cost-effective choice for some, a mobile imaging service is an excellent option that can help meet your need without incurring the long-term cost burden.

MACRA: Meaningful Use, PQRS and what lies ahead for reimbursements

Posted on: 02.23.17

The complicated nature of MACRA’s rollout may have left some healthcare providers behind, but significant changes are on the horizon, so it’s important to stay up-to-date on the changes. The Medicare Access and CHIP Reauthorization Act, better known as MACRA, affects all practices — big and small — and the mandates already in place will affect the bottom line of your practice in 2017 and beyond. These new rulings apply to all physicians, physician assistants, nurses, anesthesiologists and other healthcare professionals, so it’s important to understand what’s quickly coming down the pike.

Meaningful Use and MACRA

Now in its final phase, the mandates of Meaningful Use were designed to reduce health disparities and improve the quality and delivery of patients’ medical care. One of the major initiatives was moving practices away from paper-based records. This alleviated the sometimes-questionable interpretation of handwriting and the opportunity for incomplete or misplaced files. By corralling all of the patient records in one locale it has also led to timely, more efficient sharing and exchange of information.

PQRS and Quality Payment Program (QPP)

The Physician Quality Reporting System, otherwise known as PQRS, includes a value-based modifier that will change how physicians are paid for their work. Medicare reimbursements — and quite likely all future insurance payments — will be made based on patient outcomes instead of procedures, as they were previously.

The Quality Payment Program, or QPP, is designed to help physicians focus on delivering the highest level of quality care. Medical practices that bill more than $30,000 annually with Medicare or treat more than 100 Medicare patients per year will have to choose between two different billing tracks: the Advanced Alternative Payment Model (APM) or the Merit-based Incentive Payment System (MIPS).

Looking into the future, to accelerate the alignment of quality measurement and program policies, MACRA will be discontinuing adjustments for PQRS, VM, and the EHR Incentive Program at the end of 2018 to be replaced with MIPS beginning January 1, 2019.

Pros and cons for bottom-line reimbursement

A key component to this incentive-based program is the pool of Medicare reimbursement funds and how it will be distributed. MACRA’s mandates will bring significant cuts in Medicare reimbursements for non-compliance of these new rules, which are continuously being tweaked and adjusted to address changes in the industry.

Conversely, proper compliance and high ratings of the value-based modifiers can provide significant bonus funds for medical practices. These new rules immediately affect all medical practices, hospitals, and practitioners. While complicated, it is critically important to get up to speed on these rulings. Understanding and correctly implementing them could make a significant difference in your bottom-line dollars.

Understanding the requirements of a Quality Improvement (QI) program

Posted on: 02.16.17

Maintaining a successful and accredited nuclear lab requires a consistent Quality Improvement program. However, many practices may be intimidated by what they believe to be a highly detailed and complicated process. The truth is, maintaining a successful QI program is easier and more straightforward than you think.

The accreditation process is intended to be adaptable in order to continuously accommodate medical advancement. As such, there is a lot of flexibility to enable your program to work within the parameters of your own lab, no matter what the size.

Six components of a successful Quality Improvement program

There are six components of a successful quality improvement program. Let’s look at each one and discuss them in a little more detail:

1. Test appropriateness

While there is not a specific process required to assess test appropriateness, it is important that you have a process in place that confirms the appropriateness of tests in a way that works for your particular lab. For example, a smaller lab might review all studies at the end of a week to determine whether or not the tests fit the diagnoses; a larger lab might sample a specific number or a percentage of studies each month and document as appropriate, not appropriate, or questionable. If you need more information or assistance with test appropriateness, there are tools available via the IAC website. You can also use the guidance given in the Appropriate Use Criteria guidelines.

2. Technical quality and safety of images

This component requires you to define the protocol for the use of your imaging equipment and document it daily. This could be as simple as a checklist on your daily log sheet that confirms proper camera operation prior to seeing patients each day.

3. Interpretive quality review

This checks-and-balance system continuously audits the procedures performed in your lab. It ensures that there is consistency in the data and adherence to the protocol for each study performed by each technologist. The review can be done via committee, or perhaps a process whereby doctors review a sample of each other’s reports.

4. Report timeliness and completeness

Keep accurate and complete records. The IAC offers guidelines for information that should be included in reports. At a minimum, all reports should have a final signature within 48 hours of the test completion. They should also be reviewed regularly to determine that all personnel are maintaining consistent data.

5. Correlation between tests/studies

This step can be the most problematic as it requires comparison of studies that might have been completed outside of your lab, in a hospital or another lab, for example. Establish a protocol to review and compare the correlation between the results of the various tests.

6. Semi-annual review of this data

A semi-annual review of the data is required and should include all appropriate members of your staff: physicians, technologists, and other staff, and include a detailed discussion of shortcomings and areas in which to improve. Meeting minutes are required from these reviews, and the results are required to be distributed to all team members to be used as an ongoing learning opportunity.

Documentation, maintenance, and support

One of the most important components of accreditation maintenance is consistent documentation. But it’s also critical to understand that the IAC, the ACR, and the other accreditation bureaus are there to help you maintain your accreditation. Use them as a resource, to field questions, to offer guidance, to tell you what the next steps are.

Don’t allow the fear of disclosing something you’re doing incorrectly be a what keeps you from finding out how it should be done or how it could be done more quickly or more efficiently. Yes, these governing organizations are the authorities, but they are in the business of supporting those that are already accredited and helping them meet and exceed the standards.

Healthcare QuickLinks: Bundled payments, MACRA, isotope supply and more

Posted on: 02.09.17

CMS releases final rule detailing bundled payment models for cardiac services

In an attempt to encourage coordinated care, improve the quality of care and decrease costs for heart attack patients, the Centers for Medicare and Medicaid Services released the final rule for Advancing Care Coordination Through Episode Payment Models, the Cardiac Rehabilitation Incentive Payment Model, and changes to the Comprehensive Care for Joint Replacement Model that finalize bundled payment models for certain cardiac conditions and procedures in select geographic areas. The final regulation introduces a new cardiac rehabilitation model and a pathway that helps physicians who are heavily involved in bundled payment models to qualify for incentives as part of the Advanced Alternative Payment Model track beginning in performance year 2019. Continue reading…

Group calls for global research effort into gadolinium

Two European researchers are forging ahead with their proposal to collect clinical experiences and outcomes with gadolinium-based contrast agents (GBCAs) and store the information in a worldwide database. The ultimate goal is to further advance research into GBCA safety, as outlined in the January issue of Radiology. Continue reading…

US-Australian partnership will secure isotope supply

A Dallas-based company has plans to ensure a steady U.S. supply of the most commonly used medical radiotracer, utilizing an expanded Australian reactor and an innovative supply chain. U.S. Radiopharmaceuticals, a subsidiary of NuView Life Sciences, has partnered with the Australian Nuclear Science and Technology Organization (ANSTO) to create a scalable supply of technetium. The partnership is leveraging a $169 million investment from the Australian government that will go toward expanded production capacity at the Open Pool Australian Lightwater reactor, an isotope production facility just outside of Sydney. Continue reading…

Smokers not picking up the CT lung screening habit

Low-dose CT lung cancer screening may be reimbursed by insurance now, but you’d hardly know it by the low numbers of high-risk smokers taking advantage of it. In a study, researchers from the American Cancer Society’s Surveillance and Health Services Research team in Atlanta examined results from more than 2,000 respondents to the National Health Interview Survey in 2015. They compared these results with responses to the same survey acquired in 2010. Continue reading…

Is that a miniature MRI in your ambulance?

Imagine an MRI scanner that’s 50 to 60 times cheaper than what’s on the market now, small enough to tote around in a standard ambulance and strong enough to find brain bleeds, stroke damage, tumors and more. Physicists at Mass General’s Martinos Center for Biomedical Imaging are working to prototype just such an apparatus. Matthew Rosen, PhD, of Harvard tells Stat News his team’s idea is to “take the magnet out of the equation, to turn the magnetic field down as low as possible to make it safe but also at the same time to make it cheaper, lighter and more portable.” Continue reading…

Permitted financial arrangements between participant hospitals and physician group practices under the new cardiac-related episode payment models

Pursuant to its recently issued final rule, CMS is implementing two cardiac-related episode payment models . One of the EPMs pertains to episodes of care surrounding an acute myocardial infarction; the other EPM pertains to episodes of care surrounding a coronary artery bypass graft. Generally, participation in the AMI and CABG EPMs is mandatory for all IPPS hospitals located in one of the 98 MSAs designated by CMS. Continue reading…

Nine things healthcare executives should know about MACRA

Although CMS released the final rule for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) in October, there is still quite a bit of confusion. In fact, nearly half of U.S. physicians are not even familiar with MACRA, per Deloitte’s recent survey of 600 doctors. What’s more, nearly eight in 10 physicians said they prefer fee-for-service over the types of risk-bearing, value-based arrangements under MACRA. Yet, MACRA is here to stay. The final rule proposes changes that will have a major impact on providers and propel the healthcare industry toward a better future with value-based payment models. Here are nine things to know about the final rule: Continue reading…

6 tips for keeping your nuclear lab profitable

Posted on: 02.02.17

Nuclear laboratories in physician offices and hospitals require expensive equipment, trained staff, plus the costs of isotopes and other pharmaceuticals. These factors may be major contributors to a lab’s costs, but there are many other opportunities to consider for increasing the bottom line.

Here are six tips that can make a big difference in the profitability and efficiency of your nuclear lab:

1. Lab space

Consider the size of your current lab space. Is it larger than it needs to be? New equipment often requires a smaller footprint and the updated technology would likely allow you to accommodate higher patient volume. Reconfiguring your space may also provide the square footage you need to create an additional exam or procedure room. While decreasing space can save money, increasing the number of patient services delivered in the same amount of space will also lead to increased profits.

2. Licensing and Compliance

The costs associated with licensing and safety compliance are ongoing expenses in both time and manpower. Are you using the right efficiencies in maintaining them? For example, if compliance audits are required twice per year, why perform a third?

Consider the effective use of your workforce. Is your highest paid employee spending hours each month maintaining safety requirements? You could save money by outsourcing that work or allocating it to a less expensive employee. Be sure your employees’ job responsibilities and the tasks they’re performing are in line with the skill sets their salaries warrant.

Also, if you are a Radiation Safety Officer for your practice or multiple practices consider how much time you spend on these functions. From a profitability standpoint, how much revenue productivity are you missing while performing those tasks? Most physicians know their average revenue per hour and it is likely to be significantly more than outsourcing RSO duties and/or outsourcing the Radiation Safety Program. In terms of personal life, a physician taking on these tasks “after hours” may be pleasantly surprised at the benefit of investing just a few dollars in order to spend more time with family and friends. Though it’s hard to put a price on work-life balance, outsourcing these functions is a fairly inexpensive proposition.

3. Costs of consumables

Band-Aids, cotton balls, IV tubes, Derma tabs, saline, and more…these incidental costs can add up to $10 – $20 per patient, per procedure. Does your practice have a protocol that maximizes the efficiency of these items? Reducing costs from $20 to $10 per patient seems insignificant until you realize that a $10 savings for a volume of 5,000 scans per year increases profitability by $50,000. That’s a significant savings and a substantial impact to your bottom line.

You should also consider the prices at which you’re purchasing these items. Are you getting the best price available? Market resources including buying groups and industry consortiums can be beneficial to decreasing the overall costs of these items.

4. Maximize the patient experience

There’s no question that patients appreciate efficiency too. Are you optimizing patient protocols in order to keep the length of their visit to a minimum? Do they leave your office feeling they’ve had a positive patient-centric experience that was equally respectful of their time?

Consider the patient whose four-hour appointment could have easily taken three hours. This not only increased the office resources consumed by the patient, but you’re risking the chance that the patient will search for another office the next time. After all, they need to find a more efficient use of their time as well.

5. Efficient scheduling

Optimizing the practice’s scheduling can make a significant difference in both income and costs to the practice. For example, if Tuesday requires overtime costs for lab techs and front office staff and Wednesdays sees only 60% volume, both have negatively impacted the bottom line.

Patient no-shows can also be detrimental to your profitability. How does your practice minimize no-shows? We’ve recommended educating patients about the materials used for their test––like isotopes, for instance. Before their appointment, the patient should be well aware that the materials are individually ordered and cannot be used on the next patient if they miss their appointment. You also might consider holding a monthly gift card drawing for patients who kept their appointments as a simple way to say thanks. Check out more ideas here.

6. Re-evaluate over time

To understand profitability, think like an accountant. If that’s not your strong suit, consider appointing someone within the practice — or even outsourcing this function — to help you optimize the profits for your practice.

As in any business, variables change and it’s important to re-evaluate them on a regular basis. Managing profitability is an ongoing process so be sure to continually monitor checkpoints and make adjustments when necessary. The ultimate success of your practice will depend upon it.

Digirad Sonographer published in Journal of Vascular Ultrasound

Posted on: 01.26.17

Digirad is proud to announce that sonographer Adam E. Jackson, RDCS, RVT’s recent reports on splenic artery aneurysms and spontaneous hepatic artery dissection were published in the December 2016 issue of the Journal of Vascular Ultrasound. The rarity of both cases, coupled with the use of ultrasound versus the typical CT, MRA or endoscopic modality, made his findings even more notable.

Case I – Splenic Artery Aneurysm

Case I was a young, healthy female, age 38, who was diagnosed with multiple splenic artery aneurysms. A splenic artery aneurysm is a dilation in the splenic artery, the blood vessel responsible for supplying the spleen with oxygenated blood.

Ultrasound is not a traditional modality in diagnosing multiple splenic artery aneurysms because it has limited spatial resolution and may be difficult in cases of obesity, bowel shadowing and atherosclerosis. The patient was an ideal candidate for the procedure, and Jackson was able to manage some of the other challenges by imaging her on her side instead of transversely through the abdomen. This allowed for a better view of the spleen. With the help of color flow technology, four aneurysms were found in the same vessel, which is extremely rare.

Case II – Hepatic Artery Dissection

Case II was a healthy, 54-year-old, male with hepatic artery dissection, a separation of the layers of the artery wall. It is an uncommon clinical event with very few reported cases in medical literature. This patient fit the demographics of the few reported cases but was unique in and of itself. Every other case study was diagnosed via CT. An initial ultrasound showed evidence of a “string sign” and Jackson was able to reproduce the same results to confirm the diagnosis. Ultimately the case demonstrates a very rare CHA variant that is present in only 1.3% of people and with a dissection in the CHA that has an incidence rate of less than 0.25%.

Click here to read the full report on splenic artery aneurysms and spontaneous hepatic artery dissection

Proper comparison is key when considering supine vs. upright imaging

Posted on: 01.19.17

Cardiologists and their patients are learning more than ever about the benefits and limitations of supine vs. upright positioning for nuclear diagnostic imaging. While horizontal, face-up scans taken while patients are lying flat is the traditional method, upright imaging is a well-established method that has gained popularity, most likely due to the comfort and ease of use it offers to both the patient and the technologist.

Proper comparison is the key

Although both approaches have pros and cons, the key to proper image analysis is the comparison with a system-matched, multi-site, low-likelihood normals database. Due to the differences in anatomic distribution of potential sources of artifacts, quantification of the two methods will vary by gender, and by imaging convention (upright or supine). There may also be differences in system resolution, collimation, acquisition, and processing protocols including reconstruction algorithms, as well as filtering approaches and choices required for imaging. When using a normals database for comparisons, one must be certain to use a database of true comparables with regards to these variables. The normals database should include separate images for male and female anatomies.

A matter of patient comfort

Clinically, choosing one position over the other does not impact the imaging results. Physicians are finding confidence with both methods. There are some distinct differences, however. When in the supine position, patients are instructed to lie completely still with their arms above their head. Unfortunately, some patients, particularly those with shoulder or arm impediments, find this especially uncomfortable and a difficult position to hold. Also, it’s necessary for the scanners to be close to the patient’s head and face, which may bring on the feeling of claustrophobia.

In contrast, in the upright position, patients are seated with their arms rested on the device’s armrest, which is a much more natural and comfortable position. The camera’s detectors are much less imposing, providing significant improvement in comfort, and may help lower the patient’s anxiety level. These comfort-centric advantages often improve patient compliance, leading to minimal patient movement, which reduces motion artifacts in the final images.

Position change leads to reading ease

In the supine position, where the patient is lying down, versus the upright position, where the patient is sitting in a chair, the patient’s organs will settle differently. For example, when a patient’s arms are raised in the supine position it can cause a shift in the diaphragm, which, in some cases, may obstruct a clear view of the heart. In this instance, upright imaging offers the benefit of allowing the technologist to center the heart in the field-of-view, without extending the torso, thus keeping the diaphragm lower, and reducing the potential for diaphragmatic artifacts.

Therefore, parallel comparison is key: Supine patient studies should be scored against a normals database created with studies acquired on a supine system; upright patient studies should be compared to a normals database created with studies from an upright system.

Healthcare Quicklinks 1701

Posted on: 01.17.17

Cardiovascular biomarker score helps identify atrial fibrillation patients at risk of stroke, death

An analysis of a randomized trial found that a cardiovascular biomarker score may help predict the risk for stroke, systemic embolic events and death in patients with atrial fibrillation. The biomarkers were cardiac troponin I, N-terminal pro-B-type natriuretic peptide and D-dimer levels. Lead researcher Christian T. Ruff, MD, of Brigham and Women’s Hospital and Harvard Medical School in Boston, and colleagues published their results online in JAMA Cardiology. Continue reading…

Clear and present danger: Act now on medical device cybersecurity

The current state of medical device cyber readiness and compliance requires an immediate industry-wide call to action. Manufacturers and healthcare providers must collaborate to identify cyber security and privacy risks, to plan for mitigation and remediation, and to ensure that all patients are safe and secure. As medical device manufacturers continuously update and maintain their device portfolio, as well as innovate new products, the need to embed cyber security and privacy capabilities into the design, build, and maintenance of these devices is fundamental. Continue reading…

How doctors can manage MACRA

2017 will bring a lot will change for clinicians who treat Medicare patients, and yet many physicians and nurses don’t understand what they need to do. Effective January 1, how doctors treat Medicare patients will be measured by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). It’s part of the overall move away from fee-for-service to value-based care. By 2018, HHS seeks to have 90 percent of Medicare payments linked to quality. Here’s how doctors can manage the transition: Continue reading…

Pay-for-performance is here to stay – hospitals better pay attention

Soon a significant chunk of hospital revenue will be at risk, under a series of Medicare pay-for-performance programs. The idea behind P4P is simple. Third-party payers, like insurance companies or the Medicare program, will monitor the quality of care offered by health care providers like hospitals. High-quality providers will receive more money than low-quality ones, thereby giving providers an incentive to improve the quality of care they provide. Medicare has created several P4P programs, which, unless they are halted by the Trump administration, are slowly coming into effect. By 2017, these programs could put a sixth of Medicare payment at risk. Continue reading…

Marketing is a must for small practices

Years ago, it was not ethical to advertise your practice. You were only allowed a small picture of yourself with an announcement that you had opened a practice listing your training and office hours as a one-time write up in the local newspaper. Your practice was built on word of mouth and referrals from other physicians. Later, the Justice Department and the AMA reached an agreement permitting physicians to advertise without facing the ethical issues for doing so. Medicine isn’t just a profession, it’s also a business. To stay in business, you have to market yourself. Continue reading…

10 collection tactics for high-deductible patients

Patient collections are much more than collecting $10 copays: those days are long gone. Patients are paying a greater percentage of what you get paid and will be paying an ever higher percentage in the years to come. Smart and consistent patient collections tactics must be a part of every practice’s financial strategy. Consider a few eye-opening stats from a 2015 survey from the Kaiser Family Foundation on employer health benefits that emphasize why patient collections must be a priority now and for the foreseeable future: Continue reading…

Digirad’s Top 5 Blog Posts from 2016

Posted on: 01.12.17

5. Section 179 tax savings medical equipment

In today’s competitive environment, it’s important to continually reinvest in your practice so you can provide patients with the highest quality of service. Through Section 179 of the IRS tax code, the U.S. government provides a way to encourage small business owners to take that financial leap. This much-needed tax relief may be the motivation to buy equipment sooner than later and ultimately help grow your practice. Continue reading…

4. Radiation exposure guidelines nuclear imaging

Advancements in medical imaging technology have revolutionized health care, allowing doctors to more accurately diagnose disease and improve patient outcomes. These advancements include a variety of techniques that create detailed images and demonstrate the functionality of organs and tissue inside the body through the use of radiology or radiopharmaceuticals. The word radiation may stir-up heightened concern, especially if you are having multiple tests performed. Continue reading…

3. Key differences between holter monitors and telemetry

Both Holter monitors and mobile cardiac telemetry (MCT) provide ways to monitor a patient’s electrocardiogram for an extended period of time. Their main purpose is to determine the cause of a transient event by recording a patient’s heart rate and rhythm during normal activity. Although similar, Holter monitors and MCT devices have distinctive differences and meet different needs, which impacts the physician’s choice of monitoring method. In this post, we’ve outlined some of the distinct differences. Continue reading…

2. Common questions about mobile imaging

Many physicians are curious about mobile imaging but have questions about the service and how it actually works. As a leading provider of mobile nuclear imaging, the Digirad team has met with thousands of practices and cardiology providers. Here are the answers to the most common questions we receive. Continue reading…

1. Understanding attenuation correction

Attenuation correction is a mechanism that removes soft tissue artifacts from SPECT images. Attenuation artifacts vary among patients, but the most common corrections are to artifacts associated with breast attenuation in women and diaphragmatic attenuation in men. Ultimately, the goal is to reduce the impact of attenuation in order to provide images that are more uniform and allow for higher reading confidence. Here we explore several methodologies of attenuation correction associated with Myocardial Perfusion Imaging. Continue reading…

What referring physicians need to know about breast density

Posted on: 01.10.17

It’s increasingly understood that dense breast tissue is an area of concern for women’s health. Not only is a woman’s risk of developing breast cancer greater with the highest density, it also can mask small masses along with increasing medical evidence that woman with higher breast density have a higher cancer reoccurrence rate.

To date, 29 states have passed laws that require patients with dense breast tissue to be notified through some level of formal communication. Unfortunately, however, the rules and regulations vary greatly across each state. This has created uncertainty and confusion both for the patients and medical providers.

Notification Best Practices

Recommendations and suggested next steps for those identified as having dense breast tissue vary from provider to provider. Some facilities will review the results of a mammogram in person with the patient, discuss the density, and offer recommendations about next steps. More often, however, facilities comply with the minimum requirements, which may include mailing a letter to the patient, but does not require the inclusion of an explanation of breast density, the concerns that accompany it, or what other actions might be recommended. While this approach meets the requirement of the law, it often leaves patients alarmed and confused by the news with no context or professional advice.

Regardless of whether you reside in one of the 29 states, the need to address breast density and the concerns that come with it is indisputable. Because of the increased risk it brings, educating patients and recommending additional screening options as part of their care plan is every physician’s responsibility as a trusted authority. It’s incumbent upon them to step up and not only notify patients about their dense breast tissue, but to explain what it means to them and what they should do about it.

Moving from Ultrasound to MBI

All providers agree that screening methods should be as quick, accurate and cost-effective as possible. Typically, following mammography, ultrasound fits the bill and traditionally has been the most popular follow-up screening method for patients with dense breast tissue. However, ultrasound is a study that looks at the structural aspect of the breast density and may not be able to accurately see beyond the fibrous tissue leaving some valid concern about any hidden cancerous cells.

Another modality, molecular breast imaging (MBI), is gaining more attention in the medical community. The physiologic image produced by MBI is an alternative view that could increase clinical confidence and ease concerns. With MBI, the injected radioactive tracer highlights areas of concern making cancerous cells easier to detect within or behind the fibrous tissue.

Of course, there are other factors that need to be considered, such as family history, personal medical history, radiation exposure and even financial issues because of the increased cost, but MBI may be a viable screening option for some patients. In the absence of well-established appropriate use criteria, physicians are left to determine which options are best for their patients and should take advantage of all that is available to them.

Education is key

As a medical professional or physician, it’s important to further educate yourself on breast density, the heightened concerns, the improved technology within the industry, and how you can best educate your patients. Patients are looking to you for guidance, and the ultimate level of service you can provide is your best, most confident recommendation for next steps.

Are all MCT’s Created Equal?

Posted on: 01.05.17

As cardiac monitoring technology has developed, mobile cardiac telemetry (MCT) has proven to be the most effective method for identifying and managing patients with asymptomatic arrhythmias, complete syncope, medication titration, post CABG, and post ablation. But are all MCT devices the same? The short answer is no.

The next generation of MCT

The Telerhythmics TCAT3 is a mobile cardiac telemetry device that incorporates the most industry advanced features and is supported by a staff of seasoned clinical experts. The device includes onboard patient compliance technology, is flexible, single component, and easy to use. The clinical features include Beat-to-Beat Analysis and Full Disclosure.

The TCAT3 Advantage

While there are many MCT systems available, the TCAT 3 has several advantages, including:

A higher diagnostic yield, particularly when compared to holter or event monitoring.
Improved outcomes when managing patients on antiarrhythmic drugs.
Substantial cost savings in the hospital for ablation, CABG, heart/pericardium, and valve/septa procedures.
Immediate access to potentially dangerous cardiac rhythms.
The accurate and continuous capture of ECG information and the relay of critical data to the physician promptly and without the need for patient participation.

A Closer Look at MCT Features

Mobile cardiac telemetry devices and providers offer widely different features, and it’s important to know what type of MCT is being used before making a decision. Items such as Beat-to-Beat Analysis percentage, type of disclosure, and patient compliance requirements will all affect the net results. The chart below compares four types of MCT solutions and highlights the options you have.

MCT (Mobile Cardiac Telemetry) device comparison chart

What types of positions does Digirad hire?

Posted on: 01.03.17

Digirad is a diverse company that offers unique career opportunities for medical professionals. From seasoned veterans to recent college graduates, we’re looking for the most qualified medical professionals in our industry. So, what types of positions does Digirad hire? Let’s take a look…

Nuclear Medicine Career Opportunities

Most of our positions are in mobile healthcare, so you should be a self-starter, enjoy being on the go, and working independently. Tech savviness is a must as we use technology to submit reports and communicate with the home office. We’re looking for energetic, professional candidates with strong communication and customer service skills that will proudly represent our company.

Cardiac Stress Technicians (CST)
We generally look for a skill set that includes emergency medicine and advanced cardiac life support (ACLS). The training and experience of a paramedic or an Emergency Medical Technician (EMT-I) is an excellent match for the qualifications of a Cardiac Stress Technician. Exercise physiologists, EKG technicians, and nurses may also be a good match for this role.

Ultrasound Technologists
The ultrasound technologists we seek are generally specialists in echo, vascular or general ultrasounds. Very few candidates specialize in all three modalities, and those that have all three are highly sought after. This is a degreed position with the ability to earn additional registries for specialties. These candidates are also known as Sonographers from hospitals, imaging centers, and other healthcare providers.

Nuclear Medicine Technologists
Nuclear Medicine Technologist is another degreed position with certification by NMTCB or ARRT(N), and requires additional skills. Digirad NMTs are in different offices each day, so communication, dealing with different personalities, and being able to take direction is key. Digirad NMTs represent the highest standard of excellence in the field.

CT, MRI, and PET/CT Technologists
DMS Health Technologies is a division of Digirad that specializes in mobile healthcare. We typically hire mobile techs for field positions who are either CT/MRI specialized or CT/PET specialized. Candidates should have the appropriate licenses and certifications and be able to demonstrate the knowledge, skills, and abilities to perform the imaging procedures that meet the quality expectations of the patient, the referring physician and the radiologist. Following orders and protocols, administering medication, viewing images for quality and transferring them to the customer for interpretation are the key responsibilities of these positions. These positions also travel a given route during the workweek and, depending upon the customers’ locations, may require an overnight stay.

Cardiac Monitoring Career Opportunities

Digirad’s cardiac monitoring division, Telerhythmics, provides 24-hour monitoring by experienced critical care trained nurses who maintain expertise in adult and pediatric electrophysiology. This division looks for:

Cardiac Trained Nurses
Either an RN or an LPN who has gained cardiac experience from working in a hospital setting or an independent diagnostic facility setting can fill our nurse positions. Fluent EKG reading is a must, as is strong communication and customer service skills, since speaking and coordinating with patients and physicians via telephone is a major responsibility of this position.

Clinical Technician
The clinical technicians we hire must be CCT or CRAT certified and have some prior work experience in a hospital telemetry setting or an independent diagnostic testing facility setting. The training and EKG reading experience of an Emergency Medical Technician (EMT) is also a qualifying match for our clinical technician position. Our most sought-after candidates are energetic with strong communication skills who have the technical training, but also excellent customer service skills.

Does this sound like you?

At Digirad, we continually search for candidates who are driven and motivated, are self-starters and look forward to exercising authority and autonomy in managing their workday. If you have the experience and are looking for more freedom, a consistent schedule, and to be part of a select team, Digirad may be the ideal place for you.

Renew Your ASNC Membership Before Dec. 31st

Posted on: 12.20.16

Your membership in the American Society of Nuclear Cardiology, the only professional organization dedicated to the field of nuclear cardiology, provides you with access to valuable resources that help you achieve your nuclear cardiology career goals. Complimentary subscriptions, access to the Advocacy Action Center, discounts for the ASNC annual meetings, free continuing education opportunities, and inclusion in the online membership directory are just a few of the benefits you’ve enjoyed during the past year.

As the end of the year approaches, so does the deadline for your 2017 ASNC membership renewal. Be sure to renew online and pay your 2017 dues before midnight on December 31 to avoid a lapse in your membership. If you have questions about your membership contact ASNC via e-mail at membership@asnc.org or by phone at 301.215.7575.

Healthcare QuickLinks 1610

Posted on: 12.15.16

Risk model performs poorly at predicting atrial fibrillation

An analysis of electronic medical records (EMRs) found that a previously validated risk model for predicting atrial fibrillation did a poor job predicting atrial fibrillation. The model underpredicted atrial fibrillation in low-risk individuals and overpredicted atrial fibrillation in high-risk individuals. The model was developed in 2012 in the Cohorts for Heart and Aging Research in Genomic Epidemiology-Atrial Fibrillation (CHARGE-AF) trial. Lead researcher Matthew J. Kolek, MD, of Vanderbilt University in Nashville, Tennessee, and colleagues published their findings online in JAMA Cardiology. Continue reading…

CMS launches final MACRA rule

The Centers for Medicare & Medicaid Services released the long awaited final MACRA rule on physician payment. Compared with a previous draft rule issued last April, it eases the reporting burden for clinicians and triples the “low-volume” threshold dollar amount for mandating participation, to practices that bill more than $30,000 in a year or care for more than 100 patients. CMS also announced an interactive website and additional resources and training for small and rural practices. Continue reading…

Free webinar: Putting the patient at the center of care in nuclear cardiology

On both November 14 and November 15, 2016, astellas will be hosting a free live webinar:“Putting the Patient at the Center of Care in Nuclear Cardiology” is a webinar focused on today’s shift toward patient-centered care, the importance of patient-provider communication, and strategies of applying patient-centered care in nuclear imaging. To continue reading and to register click here.

CMS taps physician expertise to relieve administrative burden under MACRA

CMS is launching a physician-led initiative to reduce administrative burden and improve satisfaction within the Medicare program, the agency announced. The long-term effort, led by senior CMS physicians, will begin with an 18-month pilot project to reduce medical review without sacrificing integrity for physicians participating in some Advanced Alternative Payment Models under the Medicare Access and CHIP Reauthorization Act. These APMs are considered the most advanced models of care under the proposed MACRA rule because they require a provider to shoulder more than nominal two-sided risk. Continue reading…

Risk of ‘mass exodus’ of doctors from Medicare

In what may be the most significant modification to Medicare since the program began in 1966, on Oct. 15, the Centers for Medicare and Medicaid Services (CMS) released the final rule for implementing the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). It dramatically changes how Medicare pays doctors for their services. Does it really matter how doctors get paid? Yes — the success or failure of the new payment system will profoundly influence the future of the U.S. health care system. And while the goals of MACRA are laudable, its implementation carries a number of unknowns and the potential for unintended consequences — for patients and doctors alike. Continue reading…

Interruptions are part of the job for nuclear medicine techs

What happens when nuclear medicine technologists get interrupted while working with dangerous, expensive radiopharmaceuticals? Sometimes, these interruptions lead to better patient care. In fact, attempts to control interruptions might be counterproductive, according to a BMJ Quality & Safety Journal study published online. Nuclear imaging technologists work in busy environments with a range of tasks and interruptions that could increase the risk of medical errors. However, the study authors found these technicians have effective systems in place to deal with constant interruptions. Continue reading…

ACC president comments on final MACRA ruling

Shortly after the release of final ruling on the Medicare Access and CHIP Reauthorization Act (MACRA) Oct. 14, American College of Cardiology (ACC) president Richard A. Chazal, MD, commented on the legislation. “This final rule demonstrates the complexity of moving to a value-based payment system under Medicare; however, we are encouraged to see that CMS has made several changes in the final rule based on comments by the clinician community,” Chazal said in a news release.“ Continue reading…

Digirad named as top 10 fastest growing healthcare solutions provider

Posted on: 12.08.16

Digirad Corporation was named one of Insights Success Magazine’s 10 Fastest Growing Healthcare Solution Provider Companies for 2016. With the US Healthcare industry rapidly evolving in the advancement of technology, digital media, and mobile devices, Digirad is setting the industry standard in delivering convenient, effective, and efficient healthcare solutions on an as needed, when needed, and where needed basis.

Why Digirad?

Digirad’s portfolio of services and diagnostic imaging products continually improve healthcare performance, optimize outcomes, and enhance the patient experience. The company is highly respected for its diverse offering of mobile healthcare solutions including Mobile Nuclear Cardiology, Mobile Ultrasound, Remote Cardiac Patient Monitoring, Mobile MRI, Mobile PET/CT, Mobile CT, and Mobile Mammography.

A word about strategy

Matt Molchan, President, CEO and Director of Digirad Corporation began his career with Digirad in May 2007. When he spoke about the company’s success and the strategy that supports it, he said, “We are in constant contact with our customers. Since the majority of our business takes existing products and mobilizes them into a service—we do not need to have a large R&D team—but instead we need a company of innovative thinkers that look for ways to maximize assets by making the assets more efficient through portability and mobility.”

Future growth

Digirad’s mobile services division still has more work to do. They anticipate continued growth and innovation as they work with hospitals to reduce costs, offer greater conveniences, and improve patient value and satisfaction. The company is committed to the highest level of quality service, and providing exceptional care. With goals like those, Digirad is poised to remain the industry leader in healthcare solutions.

To read the complete Insights Success article, click here.

Upcoming Nuclear CME credit opportunities from ASNC

Posted on: 12.06.16

ASNC’s educational programming is at the core of the society’s mission to provide optimal nuclear cardiology services. The organization offers a variety of courses including interactive web-based activities for CME and CE credit that are designed to increase learners’ competence in the field of nuclear cardiology. These online activities include Meetings on Demand that present digital recordings of live meetings providing on-demand access to some of ASNC’s most popular courses, Journal CME/CE articles, and Self Assessment Modules (SAMs) that allow you to measure your knowledge in nuclear cardiology, and Webinars.

With the end of the year quickly approaching, here are the activities that will expire in December of 2016 and January 2017:

CME: Applying Appropriate Use Criteria in Clinical Practice: Lessons in Choosing Wisely

This is an online case review roundtable activity that highlights the importance of discussion of appropriate use criteria with referring physicians, reinforces the role of clinical judgment and proposes strategies to reduce the number of rarely appropriate studies. Physicians and technologists will gain a better understanding of the value of myocardial perfusion imaging and the role other imaging modalities have for selected patients. The activity offers .5 CME/CE credits and the expiration date is December 3, 2016.

CME: Enhancing Your Nuclear Cardiology Practice Video Series

These are four individual activities addressing best practices in four nuclear cardiology topics. The format for each activity is audio/video synchronized with slides presenting interactive case studies and case challenge questions and expert vignettes. Physicians and technologists will learn about the most current and best practices in nuclear cardiac imaging. Each individual activity is free to members; non-members pay a fee of $50 each.

Pharmacologic Stress: Who, How and Why. This activity offers 0.5 CME/CE credits and expires on December 22, 2016.
SPECT: The Workhorse of Cardiac Imaging. This activity offers 1.0 CME/CE credits and expires on December 22, 2016.
Appropriate Use Criteria: Application and Benefit. This activity offers 0.5 CME/CE credits and expires on December 22, 2016.
PET: Advancing into Clinical Practice. This activity offers 1.0 CME/CE credits and expires on January 10, 2017.

To view all of the ASNC online educational products at a glance, click here.

How web-based PACS are benefiting Radiologists and Cardiologists

Posted on: 12.01.16

Advancements in online PACS have eliminated the need for cumbersome equipment and large workstations that previously tethered your reading capabilities to a single location. These cloud solutions make the management of information more convenient and more economical. As a result, cloud-based PACS are becoming an attractive upgrade for many hospitals and physicians. Let’s look at the five key ways a cloud-based PACS could benefit your practice:

Multiple Modalities

Cloud-based PACS can be used for a wide range of radiology and cardiology test modalities. These include Nuclear Medicine, Nuclear Cardiology, CT, Cardiac Cath, Echo, Vascular, General Ultrasound, MRI, and PET.

No Software to Download

The defining feature of cloud-based PACS is that they use a browser as the main viewing tool. There is no special software to download or licensing required for reading studies.

Anywhere, Anytime Access

With a cloud system, you are able to access studies anywhere and at any time. View images from your desk, your home, or the beach. Results can be retrieved from any device with internet access.

Faster Turn Times

By eliminating the need for physical disks, you are able to view and report on images more quickly. This is becoming more important as some accrediting organizations now require a two-day turnaround for studies.

Flexible Payment Options

Many cloud-based PACS providers offer a variety of payment options, including monthly or per study payment options, instead of a traditional, one-time fee. This allows you to avoid the large capital outlay typically associated with an on-site PACS.

With benefits like these, a cloud-based PACS could help you enhance patient care while improving efficiencies and effectively managing costs.

For more information about how Digirad can provide you with convenient, efficient and cost effective web-based PACS solutions, contact us at 800-947-6134 or info@digirad.com.

Quick Links No. 1609

Posted on: 11.23.16

What MACRA’s ‘go at your own pace’ could mean for providers

The shift to value-base care has fueled discussion among many experts who claim providers do not have enough time or resources to succeed under a pay-for-performance system. A Deloitte 2016 survey found 50 percent of physicians have never heard of CMS’ Medicare Access and CHIP Reauthorization Act of 2015, and a Medscape survey found 59 percent of physicians in practices with less than 25 clinicians expect to receive a performance penalty as high as 4 percent under MACRA. Failure to meet CMS’ reporting standards could result in hefty fees for practices, and many providers have called on CMS to delay the shift to pay-for-performance. Continue reading…

4 policies to improve the identification of patients with diabetes and cardiovascular disease

The International Diabetes Federation (IDF) released a report on diabetes and cardiovascular disease that said, in 2015, an estimated 415 million adults were living with diabetes and that the number could increase to 642 million by 2040. The IDF said studies have estimated that 15 percent to 41 percent of middle-age adults living with diabetes in North America, Western Europe, Australia and Japan have cardiovascular disease. The organization added that only 41 countries have high-quality data on people who have diabetes and cardiovascular disease. Continue reading…

AMA releases online tools to help doctors prepare for MACRA

The Chicago-based American Medical Association has developed several online tools to assist physicians with preparing for and transitioning to pending Medicare payment and delivery changes under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA represents the most significant change to Medicare’s physician payment system in a generation, and the AMA is working to help physicians navigate this change and make sure they are prepared for it,” AMA president Andrew Gurman, M.D., said during a conference call with healthcare industry press Oct. 5th. The new online resources include a payment model evaluator tool, practice-improvement strategies, and MACRA-focused podcasts to provide information and guidance during upcoming Medicare changes. Continue reading…

Hospitals tell CMS to slow flood of new alternative payment models

Providers are pleading with the CMS to slow its flood of new payment models in the effort to move from fee-for-service to value-based care. Since the start of the year, the agency has introduced or expanded nine pay models and announced selected markets for another three. In comments on a July proposed rule that would make 98 markets financially accountable for the cost and quality of all care associated with bypass surgery and heart attacks, industry stakeholders ask the agency to step on the brakes. Continue reading…

Using Tc 99m PYP cardiac imaging may help diagnose and detect patients with heart failure

A retrospective cohort study found that using technetium 99m pyrophosphate (Tc 99m PYP) cardiac imaging helped detect and diagnose patients with transthyretin-related cardiac amyloidosis, a cause of heart failure with preserved ejection fraction. The imaging technique also could accurately differentiate transthyretin-related cardiac amyloidosis from AL cardiac amyloidosis. Lead researcher Adam Castano, MD, MS, of Columbia University Medical Center in New York, and colleagues published their results online in JAMA Cardiology. Continue reading…

AMA launches online MACRA help for physician practices

The Medicare Access and CHIP Reauthorization Act, with its sweeping changes for how providers will be paid, is just weeks away from finalization and is set to launch soon thereafter. The American Medical Association has unveiled two new tools to help physicians navigate the new reimbursement landscape. The AMA Payment Model Evaluator and The AMA STEPS Forward collection of educational modules are both available for use on the AMA website, and require only a login to site, not AMA membership, the organization said during a conference call. Continue reading…

Understanding the challenges and opportunities of CFR testing with SPECT

Posted on: 11.17.16

Coronary Flow Reserve (CFR) quantification, used in conjunction with Myocardial Perfusion Imaging (MPI), can potentially help to rule out Coronary Artery Disease (CAD). Coronary Flow Reserve compares the myocardial blood flow at peak hyperemia (stress) with the myocardial blood flow at rest.

Currently, most coronary flow reserve testing is performed during cardiac PET imaging, but advancements in technology and the software used to process the data are enabling SPECT cameras to perform CFR evaluation. The lower overall cost of SPECT makes this improvement a promising development for patients and the healthcare system. While this is a positive step, there are some important factors to examine and consider when exploring CFR imaging with a SPECT camera.

Adjustments for CFR testing with SPECT

Longer Test Times: CFR evaluation requires an additional 6-8 minutes of dynamic imaging at time of rest and at time of stress, prior to Myocardial Perfusion SPECT. Patients would no longer be injected and sent away for perfusion imaging at a later time, but rather they must be positioned for imaging at the time of injection. Although the camera may offer the additional benefit of CFR evaluation, the additional acquisition time requirements may lower patient throughput statistics.

No treadmill/exercise stress: Since the patient is positioned prior to the exam and will be imaged at the time of injection, this limits patients to a pharmaceutical stress procedure, which may not be the preferred method. This method will also increase the cost of performing the test and is currently only reimbursed when there is a documented reason that a patient is unable to physically perform a mechanical treadmill stress test.

Additional costs for an injector: The injection, both at rest and at stress, will need to be administered at a specific volume and rate, which will require an injector.

Additional costs for software: Currently, the CFR calculation is not a standard software application. Evaluating CFR may require an additional licensing cost depending on your software package.

No MPI clinical guideline requirement: Although CFR quantification can be a potential benefit in diagnosing triple vessel disease, it has not yet been established as a clinical guideline requirement or standard. As there is no clinical guideline or standard, there is currently no incremental reimbursement or payment to offset all of the various incremental costs associated with performing CFR quantification.

Effective calculations: As with all nuclear medicine studies, good count statistics are needed to produce clinically valid data. Factors such as reduced dose and patient size can easily affect count statistics. Physicians may still hesitate to call a study abnormal based solely on CFR quantification, especially if the perfusion images appear completely normal.

CFR testing is not yet standard practice with SPECT Myocardial Perfusion Imaging and is only applicable to a small subset of patients, but technological equipment updates are in the works. Stay tuned as progress continues.

How to compare cardiac monitoring options

Posted on: 11.10.16

Cardiac monitoring is focused on the collection and interpretation of a patient’s heart rhythm. Different technologies have been developed to accomplish this goal, each with different features and methods for collecting the data. These methods include:

Holter

A Holter monitor is a short-term, continuous monitoring device that tracks the heart rhythm of a patient with small electrodes that attach to the skin. The devices are typically worn for 24–48 hours and then returned for download and analysis.

Event

Event monitors offer longer term monitoring in which the patient can trigger a recording if they are feeling symptomatic. Some event monitors can auto trigger based on internal algorithms for tachycardia, bradycardia, pause, or atrial fibrillation.

Mobile Cardiac Telemetry

Mobile Cardiac Telemetry, or MCT, allows for longer term monitoring with the ability for patient or auto-triggered events based on algorithms. Generally speaking, MCT devices “sample” or “trend” ECG samples periodically throughout the day.

TCAT3

The TCAT3 is a TELErhythmics Cardiac Ambulatory Telemetry device, which is designed for longer term monitoring. It collects every heartbeat in order to detect elusive arrhythmias. The patient can trigger recordings or the device can auto trigger based on internal algorithms for tachycardia, bradycardia, pause, or atrial fibrillation. Data is transmitted wirelessly for near real-time analysis.

Comparing Cardiac Monitoring Options

There are countless devices that allow physicians to offer cardiac monitoring services. To help you understand the differences between the various methods, we’ve compared the technologies in the chart below.

cardiac-monitoring-options-compare-chart

RSNA 2016 Show Preview

Posted on: 11.03.16

Grab your winter coat and join us in the Windy City for RSNA’s 102nd Scientific Assembly and Annual Meeting, from November 27 through December 2. More than 51,000 total attendees are expected at RSNA 2016, including 26,000 healthcare professionals, representing more than 130 countries.

These radiologists, medical specialists, administrators and staff will share experiences, network and explore new ways to collaborate. From discovering unexpected learning opportunities to broadening participation in the larger medical community, this year’s theme encourages radiologists to envision their profession beyond imaging.

RSNA 2016 will feature 435 educational courses and more than 1,700 scientific paper presentations in a variety of subspecialties. Refresher courses, scientific sessions, plenary sessions, and education exhibits will address healthcare’s latest technological innovations and techniques, offering a deeper understanding of best practices in patient care. RSNA courses will also qualify for CME credit.

Digirad will be exhibiting the Ergo and X-ACT cameras in collaboration with Dilon Technologies as part of the world’s largest medical equipment exhibitions. The Exhibit Hall will feature products from more than 600 leading manufacturers, suppliers, and developers of medical information and technology. Participants will have the opportunity to meet with manufacturer representatives to discuss their radiology products and services and learn how to use them to streamline operations and enhance patient care.

We are thrilled to be pairing with Dilon Technologies, a company that specializes in molecular imaging, to present the Ergo and Cardius® X-ACT Imaging Systems and discuss its convenient, patient-centric, compact, and solid-state capabilities. We welcome you to visit Booth #6132 to experience the latest technology available in imaging for general nuclear medicine, women’s health, pediatrics, and critical-care patients.

Healthcare QuickLinks No. 1608

Posted on: 10.27.16

Having an irregular heartbeat does increase risk of heart attack, major study finds

One million people in Britain who suffer from an irregular heartbeat are also at greater risk of heart attacks, heart failure and chronic kidney disease a new study has shown. Previously it was thought that atrial fibrillation only significantly raised the risk of suffering a stroke. Oxford University and MIT in the US analyzed the results of 104 studies involved more than nine million participants to find out if the condition effects other deadly diseases. Continue reading…

Making the transition to population health: Healthcare leaders share challenges, opportunities and a roadmap for success

As the healthcare landscape evolves, provider organizations are expanding their focus beyond individual patient care and looking toward managing the health of populations. Although the goal of population health is clear, the transition path is still murky. To provide some clarity, athenahealth brought together 79 executives from 72 accountable care organizations, health systems, provider organizations or consulting firms for a series of roundtable discussions to find out what it takes to successfully transition to a population health model of care. Continue reading…

Shilpa Medicare gets USFDA nod for Azacitidine injection

In October, Shilpa Medicare said it received US health regulator’s nod to sell Azacitidine injection, used in treatment of myelodysplastic syndrome, in the US market. “The company has received an approval from the United States Food & Drug Administration (USFDA) for Azacitidine- Injection ANDA of SEZ formulations facility situated at Jadcherla, near Hyderabad,” Shilpa Medicare said in a BSE filing. Continue reading….

Some increased bleeding risk seen with blood thinner Xarelto vs. Pradaxa

The blood thinner Xarelto may pose a slightly greater risk of serious bleeding than Pradaxa in patients with the abnormal heartbeat known as atrial fibrillation, new research suggests. Most patients with the condition take a blood thinner to reduce the risk of stroke. Although these drugs help prevent stroke, they can also cause uncontrollable bleeding, which can be fatal, the researchers said. Continue reading…

Little-known state laws are hurting patients and making hospitals worse

The Certificate-of-Need laws (CON) require providers to seek permission from their state’s government before opening a new practice, expanding services and making certain investments in devices and medical technology. It has become increasingly clear, however, that these laws have failed to achieve their goal. Adding to the skepticism, we are now beginning to understand the real effect they have on the provision of health care in America. CON laws may be diminishing hospital quality, and even raising death rates in some cases. Continue reading…

Only 11% of physicians say ACOs will improve care & truncate costs

The 2016 Survey of America’s Physicians survey found physicians are not confident accountable care organizations will improve quality and lower costs, according to McKnight’s. The survey reported that less than 11 percent of physicians said ACOs will improve care and lower costs and less than 16 percent reported being unsure as to an ACO’s structure and the program’s purpose. Continue reading…

MedAxiom Fall TransForum Conference Preview

Posted on: 10.25.16

MedAxiom’s TransFORUM Fall ’16 conference will be held October 28-30 at the JW Marriott in the heart of downtown Austin, Texas. Participants will have the opportunity to network with esteemed peers from hundreds of programs across the nation and connect with executives, consultants and industry representatives that are all part of the growing MedAxiom community.

Digirad recently spoke with Ryan Graver, President of MedAxiom Ventures, about the upcoming conference. He shared his excitement around two of the topics that are fueling this year’s record-breaking attendance–bundled payments and MACRA. They’ve dedicated an entire pre-conference session that will address the next stage in the bundled payment mandate and several conference components to understanding MACRA, evaluating the different tracks, and decoding some of the regulations surrounding the initiative.

Graver was also looking forward to some key discussions and presentations. “Our meetings are geared towards shared learning, bringing leaders together from institutions across the country to present their practices and their programs,” he said. “This year, we’re excited to have a consumer focus, so as we think about other players in the health care marketplace, we’re thrilled to have Marcus Osborne, Vice President of Health & Wellness Transformation & Innovation at Walmart as our Keynote Speaker. He’ll share his thoughts on how the healthcare landscape is being reshaped from a consumer’s perspective.”

Participants will have multiple opportunities to attend other big-picture presentations as well as participate in detailed breakout sessions and more intimate POD group discussions. As an added bonus, they’ll be able to access online video archives for ongoing education and ideas sharing.

Digirad will once again be an exhibitor at the conference. We’d love to introduce you to or answer any questions you may have about our wide range of solid-state imaging solutions—products, services or support. Be sure to stop by the Exhibit Hall and say hello. See you in Austin!

Screening options and recommendations for dense breasts

Posted on: 10.20.16

The topic of breast density is gaining attention lately. To date, 29 states have mandated some level of formal communication to inform women not only of their mammogram results, but also their breast density level. In the battle against breast cancer, there is a growing need and demand for patients to be educated about breast density and their potential need for additional imaging.

What is breast density?

Upon completion of your last mammogram, you may have received a letter informing you that you have dense breasts, and you may be wondering – what does this mean? Breasts are made up of fibrous or glandular tissue and are considered dense when the percentage of fatty tissue is low.

Although women with dense breasts may require additional screening, it is not abnormal. The additional concern is merited because studies have shown that dense breast tissue increases a woman’s risk of developing cancer, and may have some bearing on its reoccurrence. Also, because both dense breast tissue and cancerous cells appear white on a mammogram image, the greater the opportunity is for abnormalities to hide behind the dense tissue and go undetected.

What should I do?

If you’ve had a mammogram and been told that you have dense breasts, your doctor may order additional imaging, typically a screening ultrasound. If the result is inconclusive or your risk level warrants it, he or she may order a molecular breast image (MBI).

An ultrasound uses high-frequency sound waves to create an anatomical view of the breast tissue, which shows exactly how the tissue looks. With the help of a thin layer of gel, a transducer is moved across the breast creating the image, which is based on the reflection of the waves against the body. Ultrasound can be performed with or without the assistance of a dedicated radiologist, depending on the method, and there is no ionizing radiation exposure associated with ultrasound imaging. It’s also relatively inexpensive, by comparison, and the procedure takes approximately 15 minutes plus interpretation time.

MBI uses a radioactive tracer to detect cancer inside the breast. Once the tracer is injected, a nuclear camera takes a physiological image, which captures the interaction of tissue surrounding a cancer as opposed to a snapshot of how it looks. Any abnormal cells will attract a higher concentration of the radioactive substance and identify areas of concern. The MBI procedure typically takes approximately 40 minutes plus interpretation time, and is more expensive than an ultrasound. However, unlike the anatomic images produced by mammography or ultrasound, the physiologic imaging of MBI may offer more conclusive diagnostic confidence.

Take action!

Hearing that you have dense breast tissue may be upsetting, but don’t sit back and accept the uncertainty that comes with it. Take action. By communicating with your physician and discussing your individual need for additional testing, you’ll be doing everything possible to ease your mind. Screening for disease is the key to early detection and being an educated, responsible patient who takes your health seriously will help you live a long and healthy life.

Changes to IAC Nuclear/PET Accreditation Standards

Posted on: 10.13.16

2017 updates: What you need to know

The Standards and Guidelines for Nuclear/PET Accreditation are instrumental in effecting the quality of patient care that the Intersocietal Accreditation Commission (IAC) is committed to maintaining. As an accreditation organization, they work hard to ensure their program strikes a balance between the changing needs of the medical community as well as the general public. Periodically, the IAC standards are reviewed by the Board of Directors and revised as necessary.

On September 15, 2016, the IAC released an updated version of the IAC Standards and Guidelines for Nuclear/PET Accreditation, which will become effective on March 15, 2017.

Key Revisions

While some of the revisions to the standards were made for purposes of clarification or explanation of previous standards, other requirements have been modified to reflect a change. The key modifications include:

Technical Staff – The Standard previously titled nuclear medicine technologist(s) is now titled technical staff in all references.
General Protocol Guidelines –The most significant change to the newly published Standards and Guidelines is the inclusion of administered dose ranges, which have been added to the Standards in an effort to reduce patient radiation exposure in myocardial perfusion imaging studies.
Part D: Therapy Procedures – The majority of the new Part D section already existed in the previous Standards. In the updated version these requirements were moved to a new section for Therapy Protocols and Performance only.

For a summary of all the revisions made to the Nuclear/PET Standards, visit intersocietal.org/nuclear/standards/IACNuclearPETStandards2016_SummaryofChanges.pdf.

Is isotope shortage still a concern?

Posted on: 10.06.16

The supply and pricing of isotopes in the market has been gaining attention for some time now and for good reason. Nuclear medicine is dependent on a continuous supply of technetium, and the market doesn’t seem to be offering any outward sign of comfort.

Cause for concern?

In short, yes, isotope supply issues continue to be a concern in the marketplace. Currently, there is a push to move to low enriched uranium (LEU). The U.S. government has already set a mandate to move away from highly enriched uranium (HEU) source molybdenum (99Mo), which is used to make technetium-99m, the radioisotope used in nuclear imaging studies. The U.S. government, however, has not set a timeline or deadline for this change.

The situation is compounded by relatively few suppliers in the market. The production of medical isotopes is managed by eight reactors located across the globe. Once a reactor produces an isotope, it is sent to a production facility, which is usually in a different location, in order to extract the technetium-99m from the molybdenum. It is then shipped to a generator facility in the U.S. and, once processed, makes its way to the market and is ready for sale. It is a multiple step progression that works well, yet has potential problems.

New technologies on the horizon

There are viable improvements and solutions on the horizon. Companies are currently investigating new technologies, including domestic molybdenum production, experimenting with ways to ship the longer half-life radiated molybdenum, and a new resin core process that will not only add stability and reliability to the marketplace, but will also impact long-term pricing.

With the resin core process, naturally occurring molybdenum is irradiated in a university-type reactor and applied to the generator core. Domestic production, without any waste, and a simple process to market will allow for long-term, predictable pricing, which is what the current market is seeking.

What lies ahead

While traditional ways of producing technetium have not necessarily improved, there are many companies finding new, safer and more economical solutions to satisfy the demand. Millions of dollars are being spent to develop these new techniques and they will be a reality for providers across the globe. It will take time to perfect the solutions, but they are within reach.

European Association of Nuclear Medicine (EANM) Show Preview

Posted on: 09.29.16

The 29th Annual European Association of Nuclear Medicine Congress will be held at the Barcelona International Convention Center on October 15 – 19 in Barcelona, Spain.

One of the most valuable nuclear medicine meetings in the world, it offers 130 sessions and hosts more than 5,500 participants from around the world who will have the opportunity to network with colleagues, learn about new advancements and trends in the industry and be introduced to the newest groundbreaking technology. The meeting will combine the best of science and interactive learning with the beauty of Barcelona, one of the liveliest cities in Europe.

The sold out Exhibition Hall will be packed with vendors who are eager to share the latest achievements in pharmaceuticals and radiopharmaceuticals, as well as state-of-the-art equipment.

Digirad is proud to be an Exhibitor at the EANM ’16 where we’ll be showcasing the Ergo™ and the Cardius® X-ACT imaging systems, two solid-state cameras that offer unmatched imaging combined with remarkable flexibility. The Exhibition Hall will be located on the ground floor across from the Entrance Hall so be sure to stop by and visit us at Booth #11. We’d be happy to talk with you about our wide variety of cameras, the benefits they offer, and answer any questions you may have.

See you in Barcelona!

Understanding the differences between Ultrasound or MBI for Breast Imaging

Posted on: 09.22.16

If you were told after your last mammogram that you have dense breast tissue, your doctor may have recommended additional imaging. One of the details included in the mammography report from the radiologist to your doctor is information on how “dense” your breasts are.

Breast density is assigned one of four categories:

A – the breasts are mostly fatty
B – there are scattered areas of fibroglandular density
C – the breasts are heterogeneously dense which may obscure small masses
D – the breasts are extremely dense which lowers the sensitivity of mammography

Breast density may increase your risk of developing breast cancer and it can hide small masses making it difficult to diagnose. Often times, breasts that are classified as heterogeneously dense or extremely dense may benefit from additional imaging. Physicians typically opt for an ultrasound or molecular breast imaging to gain a better view and increase their clinical confidence.

Ultrasound vs. MBI

One of the main differences between breast ultrasound and molecular breast imaging is the type of image each produces, either anatomic or physiologic, respectively.

An ultrasound uses high-frequency sound waves to produce an image of the anatomy of the breast tissue at that exact location. With the use of a transducer and a thin layer of gel, the procedure creates a picture that shows the radiologist how the sound waves travel through the density and what the breast tissue looks like.

A molecular breast image produces a physiological image, which demonstrates the interaction of tissue surrounding a breast cancer or any other area of interest in the breast. It shows how the body is performing or reacting. With the help of a radiotracer, the molecular image shows how much of the isotope the tissue is absorbing. Cancerous cells will attract a greater concentration than normal healthy cells, indicating an area of concern.

If you compare these images to a weather map, the anatomical view would be the topographic map where you can see the depth of a mountain range from above, while the physiological picture would be more in line with Doppler radar, where you can see the clouds approaching and the effect they have on the covered area.

Which test is best?

When you consult with your physician, he or she will take into account your individual medical and family history, risk factors, and other health issues before making a recommendation for additional testing.

The ultimate purpose of screening is early detection, but it’s also important for tests to be as quick, accurate, and inexpensive as possible. Mammography is the least expensive method of screening, followed by ultrasound, and then MBI. If your ultrasound results are inconclusive, MBI would most likely be the next step.

MBI has 10+ years of history in the breast imaging world, but it is still considered new technology, which is one reason why appropriate use criteria for the modality is still in the developing stages. Educating yourself and communicating openly with your doctor will help accurately weigh your risk factors and address any concerns so that they can recommend a suitable screening option that meets your specific needs.

Healthcare QuickLinks No. 1607

Posted on: 09.20.16

Advances in Cardiology Will be Made by Integrating New Data Sources and Technologies

US Food and Drug Administration (FDA) Commissioner Robert Califf is calling on cardiologists to embrace new technologies and data sources, such as genetic sequencing, regenerative medicine, personal electronic devices and social media, in order to improve patient outcomes moving forward. Califf, himself a renowned cardiologist, makes the call in an editorial published in the August edition of the Journal of the American College of Cardiologists. Continue reading…

Arrhythmic Event Risk High in Early Phase of Dilated Cardiomyopathy

Patients with dilated cardiomyopathy have a significant risk of major arrhythmic events, even in the early stages of disease, according to research published in JACC: Clinical Electrophysiology. Pasquale Losurdo, MD, of University Hospital “Ospedali Riuniti” in Trieste, Italy, and colleagues studied 952 patients with dilated cardiomyopathy who were included in the Heart Muscle Disease Registry of Trieste from 1988 to 2014. They were interested in determining prevalence, characterization, and possible indicators of early sudden cardiac death/malignant ventricular arrhythmias. Continue reading…

Will Congress Repeal the Stark Law?

Imagine a world where there were no physician self-referral laws. Would physicians change their current ownership and compensation arrangements? Would fraud and abuse in healthcare rise? Would administrative burdens and costs decrease, allowing for an increase in compensation and decrease in healthcare costs? In recent hearings conducted by the Senate Finance Committee, physicians and other industry stakeholders sought not just to revamp the Stark Law, but to fully repeal it. Continue reading…

Using Tc 99m PYP Cardiac Imaging May Help Diagnose and Detect Patients With Heart Failure

2017 OPPS Proposed Rule: CMS Revises Status and Comment Indicators

The Centers for Medicare & Medicaid Services (CMS) has proposed several changes for status and comment indicators in the 2017 OPPS proposed rule in an attempt to better identify codes and services for providers. They are proposing to replace status indicator E (services not paid, non-allowed item or service) with two more specific status indicators, and four comment indicators, carrying over three already in effect. Continue reading…

Bundled Payments: Tipping Point in Value-Based Care?

The Centers for Medicare and Medicaid Services’ (CMS) latest bundled payments proposal takes a bold step toward addressing Medicare payment reform for some of the most common, complicated, and costly care scenarios in U.S. healthcare. The Bundled Payments for Care Improvement (BPCI) program was based on provisions in the Patient Protection and Affordable Care Act that aimed to test the ability of bundled payments to improve care quality by placing more onus for financial and performance accountability on providers. The program looks to transition healthcare’s traditional fee-for-service model to a more coordinated care effort with particular attention paid to post-acute follow-through. Continue reading…

See the all new X-ACT+ at ASNC 2016

Posted on: 09.15.16

Digirad is redefining nuclear imaging… again. In early 2017, Digirad will introduce the all-new, completely redesigned X-ACT+ camera to the nuclear imaging industry. With its new features and benefits, the groundbreaking SPECT/FAC camera will offer more accurate test results while reducing the cost burden to the system. You’ll no longer have to choose low specificity SPECT in order to avoid the high costs of other imaging methods. With the X-ACT+ you’ll never settle for less.

It’s everything you love about the Digirad X-ACT camera plus:

High Specificity
Attenuation Correction
Low Dose
Improved Patient Ergonomics

Be the first to catch a glimpse of the X-ACT+ as Digirad debuts the camera at ASNC 2016 on September 22 – 25, 2016, in Boca Raton, Florida. In a forum designed to showcase the latest technology, the X-ACT+ will surely be the star of the show. Stop by the Exhibit Hall and visit Digirad in Booth #310 where representatives will gladly demonstrate their newest SPECT camera and answer any questions.

When is it time for a new nuclear camera?

Posted on: 09.08.16

If you have an aging nuclear gamma camera, you’ll soon be faced with a number of important decisions that will affect the direction of your business. Over time, cameras show signs of wear and tear, many of which can be addressed through maintenance. At some point, however, when multiple, more critical issues arise, or when outdated technology leaves you at a service disadvantage, it may be time for a replacement. Is your camera at that point? Below are some of the more important questions to consider:

Is your camera…

Over ten years old?
Nearing or at its end-of-life?
Difficult to find replacement parts for?
No longer performing to the original specifications?
Causing you to question you clinical confidence?
Reporting an increased number of false positives?
Incompatible with newly released software and technology?
Delivering a less than ideal patient and technologist experience?
Providing outdated technical specifications and negatively affecting your clinical outcomes?
Experiencing excessive downtime?

What do I do?

Most practices understandably try to hold onto their equipment for as long as possible. Doing this though forces you to accept certain compromises over time: your camera may require repair more often, it may not perform to the original specifications, and clinical confidence may no longer be at its highest.

Your camera’s current performance is not the only deciding factor when it comes to replacing equipment. The decision is also driven by financial realities. Fortunately, in today’s market, there are multiple options. Most practices choose one of these three paths:

New technology: Purchase a new camera that utilizes state of the art technology to deliver higher image quality and resolution, increased patient comfort and convenience, improved clinical confidence and accuracy, capable of today’s low dose protocols and faster imaging time when practical.

Old technology: Purchase a newer model camera with fewer miles. This is a less expensive way to upgrade your camera, but consider the amount of money you’ll spend only to remain behind the technology curve. If you’re investing in upgraded equipment, your clinical outcomes should be substantially better for it.

A mobile imaging service: Partner with a mobile imaging service and avoid the investment of any additional capital expense. You’ll have the benefit of advanced technology, never worry about repairs or upgrades, and can customize a service package that can include any combination of staff, equipment, licensing, accreditation, and supplies.

You can also couple one of these options with your vendor’s trade-in program if they offer that service. Trading in your existing camera and applying the residual value to your replacement option can lighten the financial burden.

Make it better

Regardless of the option you choose, be sure to consider the needs and demands of the industry today and into the future. Healthcare is changing, and clinical accuracy is quickly becoming one of the most critical influencers among insurers and payer organizations. Any investment you make should contribute to a better patient experience, lower radiation burden to the patient, improved outcomes, or other added clinical value, all of which will ultimately help your practice successfully navigate the new healthcare business model.

ASNC2016 and Board Preparation Course

Posted on: 09.01.16

Are you scheduled for the upcoming Nuclear Cardiology Board Exam?

In conjunction with ASNC 2016, The American Society of Nuclear Cardiology will offer their Nuclear Cardiology Board Preparation Course on September 21-22 in Boca Raton, Florida.

The review course is designed to prepare participants for the certification and recertification exam in nuclear cardiology, as well as provide a broad overview and discussion of nuclear cardiology topics. The course will revisit physics, instrumentation, radionuclides and radiopharmaceuticals, stress testing, risk stratification, acquisition and processing, Gated Perfusion SPECT, Radionuclide Ventricular Function Imaging, artifact recognition, assessment of myocardial viability and radiation safety. It will also continue to build the student’s critical knowledge and competence around cardiac nuclear imaging procedures.

A maximum of 19.25 AMA PRA Category 1 credits will be earned for this course.

For more information and to register, visit the ASNC Board Preparation Course webpage.

Ready for freedom? You Have Options.

Posted on:

Are you an EMT or paramedic who’s tired of 48-hour shifts, working every other weekend, or missing dinner with friends because you’ve just finished a double shift? Crazy schedules may be fine for the short-term, but it wears on you over time whether you realize it or not. In a perfect world, you wouldn’t have to work weekends; Monday through Friday would be a typical work week, holidays would be spent with family, and “on-call” would be banned from your vocabulary.

Your skill set gives you options

You may think your particular skill set is best suited for a hospital setting where hours are long and sometimes unpredictable. That’s not necessarily the case. If you have emergency medicine or advance cardiac life support experience, if you’re a nurse, a paramedic, EMT, or an EKG technician, your skills are highly transferable. This means you have options. Hospitals are not the only employers that offer Ultrasound, Nuclear and Stress Techs a competitive salary and benefits package. If you’re looking for a change, maybe it’s time to sit down and have a conversation. What’s the harm in checking out your career options, especially if it opens your eyes to something new?

Freedom, balance, and autonomy

Digirad continuously searches for qualified candidates with these particular skill sets, and we offer competitive employee benefits packages (vacation days, health care, and 401(k) plan).

A position with Digirad provides you new-found freedom, a consistent schedule, and much-needed balance between your work life and home life. Why not leave the drama, chaos, and the bureaucracy behind and let Digirad help you build a career?

Are we a good match?

Digirad is looking for the best of the best. Not only is experience heavily weighted, but communication skills are high on the list as well. Candidates also have to be able to leverage their outstanding customer service skills and adjust their approach as needed. Depending upon personalities, that may sometimes mean taking the lead, while other times require taking direction.

If you’re an individual who works well on your own, is reliable, and self-motivated, a position with Digirad may be a great fit. If you’re looking for a consistent workweek, without on-call responsibility, this may be the change you’ve been looking for. Reclaim your weekends and holidays!

Want to learn more? We’d love to have a conversation with you about potentially joining our elite group. Contact our Career Center to start the discussion. www.digirad.com/careers

ASNC 21st Annual Scientific Session – Event Preview

Posted on: 08.25.16

The American Society of Nuclear Cardiology will host the 21st Annual Scientific Session on September 22 – 25, 2016, at the Boca Raton Resort in sunny Boca Raton, Florida.

This highly anticipated 4-day event gathers cardiologists, radiologists, practice administrators, and other healthcare professionals from around the world who want to discuss emerging research, new technology, and advances in nuclear cardiology. This year, physicians may bring their Practice Administrators for FREE, so be sure to take advantage of the offer and mention it during the registration process.

New Sessions

Some of this year’s new sessions will include discussions about SPECT MPI as well as PET MPI, essentials for enhancing image quality and patient safety, and principles for measuring and reporting myocardial blood flow. They’ll also address infiltrative and inflammatory cardiomyopathies, and you’ll have the chance to read some amyloid images and non-perfusion PET images with the experts!

Also, if you were hoping for more collaboration time, you’ll be excited to hear that there will be more opportunities to share questions, ideas, and opinions during live sessions through a new feature on the meeting app, which should prove to be a powerful engagement tool.

Visit us at Booth #310

In addition to the lectures, workshops, panel discussions, and presentations, you’ll find an Exhibit Hall filled with vendors representing the latest technology and professional services. Digirad is thrilled to, once again, be among the exhibitors at this year’s meeting. Look for us in the Exhibit Hall in Booth #310 where we’ll be showcasing the Cardius® X-ACT dedicated cardiac SPECT imaging system with Attenuation Correction that delivers High Specificity, Low Dose Protocols. You can also learn about Digirad’s SELECT programs, which maximize the quality, efficiency and profitability of your Nuclear Cardiology lab. If you are considering how to add PET MPI to your practice, find out how you can partner with Digirad Imaging Solutions’ PET Start-Up Programs.

For more information about the event, go to the ASNC website: http://www.asnc.org/asnc2016

We hope you’ll stop by and say hello!

Radiation exposure guidelines for nuclear imaging

Posted on: 08.18.16

Advancements in medical imaging technology have revolutionized health care, allowing doctors to more accurately diagnose disease and improve patient outcomes with earlier treatment. These advancements include a variety of techniques including x-rays, CT scans, nuclear medicine scans, and MRI scans, which create detailed images and demonstrate the functionality of organs and tissue inside the body through the use of radiology or radiopharmaceuticals.

Should I be concerned?

The word radiation may stir-up heightened concern, especially if you are having multiple tests performed. How much radiation is considered safe and over what time period? Do some tests bring greater exposure than others? At what point should you be concerned? These are all valid questions, so let’s look at some guidelines and actual exposure levels that might help to ease your mind. The bottom line is that medical imaging is a safe, painless, and cost-effective way to diagnose and treat disease.

Radiation exposure

The international unit used to measure the amount of radiation received by a patient is the “millisievert” (mSv). We are exposed to small doses of background radiation every day from natural sources like cosmic rays from space, radioactivity in the earth, and from low levels of radon gas. The average radiation dose per year in the U.S. from background radiation is 3.1 mSv.

How much radiation is received from medical imaging?

The average effective dose from radiologic medical imaging depends on the test being performed. They can also vary substantially, depending on a person’s size as well as on differences in imaging practices. The following chart details several procedures and the approximate average dose:

Procedure	Adult Approximate Effective Dose
Computed Tomography (CT)-Abdomen and Pelvis	10 mSv
Computed Tomography (CT)-Abdomen and Pelvis, repeated with and without contrast material	20 mSv
Computed Tomography (CT)-Colonography	6 mSv
Intravenous Pyelogram (IVP)	3 mSv
Radiography (X-ray)-Lower GI Tract	8 mSv
Radiography (X-ray)-Upper GI Tract	6 mSv
Radiography (X-ray)-Spine	1.5 mSv
Radiography (X-ray)-Extremity	0.001 mSv
Computed Tomography (CT)-Head	2 mSv
Computed Tomography (CT)-Head, repeated with and without contrast material	4 mSv
Computed Tomography (CT)-Spine	6 mSv
Computed Tomography (CT)-Chest	7 mSv
Computed Tomography (CT)-Lung Cancer Screening	1.5 mSv
Radiography-Chest	0.1 mSv
Intraoral X-ray	0.005 mSv
Coronary Computed Tomography Angiography (CTA)	12 mSv
Cardiac CT for Calcium Scoring	3 mSv
Cardiac SPECT (Myocardial Perfusion)	9.3 mSv
Bone Densitometry (DEXA)	0.001 mSv
Positron Emission Tomography – Computed Tomography (PET/CT)	25 mSv
Bone Densitometry (DEXA)	0.001 mSv
Mammography	0.4 mSv

Sources: radiologyInfo.org and imagewisely.org

Additionally, federal regulations allow professionals who work with ionizing radiation, such as Nuclear Medicine Technologists, Radiopharmacists, and Radiology Technologists, to receive up to 50 mSv of ionizing radiation per year of their professional lives, although most receive much less.

Is there a real risk?

Any medical procedure can have side effects, but when the procedure offers useful clinical information that will help your physician decide on your treatment, the benefits of the procedure far outweigh its very small potential risk. When you are better educated about the standard radiation guidelines and realistic radiation levels of a particular test, it may effectively ease your concerns and help you make a more informed decision.

Tips for making stress tests less stressful

Posted on: 08.11.16

Having a stress test go wrong or take twice as long as you expected is no fun for you, or your patients. Communication is an important tool and providing practical instructions prior to and during the test can make a world of difference. Aside from the standard list of instructions, here are some additional tips that will ensure your patient is prepared, comfortable and knows what to expect.

One week before the stress test

Patients coming directly from work may not be wearing clothes suitable for walking on a treadmill, especially one that will gradually increase in grade. Make a note to remind them to wear comfortable, loose-fitting workout clothes.
Remind patients not to apply lotions or moisturizer the day of the test.
Make sure patients know to bring running shoes, or at least comfortable shoes that are conducive to walking on a treadmill. No boots, loafers, sandals, heels, flip-flops, or any other non-supporting shoe.

Before the test begins

Take the time to explain the treadmill to your patient. It’s important to remember that this might be their first experience walking on one. Let the patient walk on the treadmill to see how it rolls before you start the test.
The location of your treadmill plays a role in how the test goes. Ideally, the treadmill should be positioned to look out a window, at a poster, or a picture. A patient’s tendency is to look down at their feet and by giving your patient something to look at, it encourages them to keep their head up and looking forward.
Talk to your patient about the symptoms they may experience during the test. Hip pain, knee pain, and muscle cramps can be direct results of walking on the treadmill. Alerting patients that these are normal and common symptoms will minimize anxiety.

During the test

Give your patient control of the test. Point out the e-stop and let them know that they can use it if necessary. This will alleviate any anxiety about being unable to stop the test if they are in excessive pain or can’t continue.
During the test, be sure to give your patient advance notice of the stages. As you increase the speed and grade every 3 minutes, let your patient know so that they feel more comfortable anticipating the changes.
Encourage your patient along the way. Tell them you’re looking to see how long they can stay on the treadmill or if they can reach a specific target heart rate. Having a goal to reach helps the overall results.
At the end of the procedure, gradually decrease the speed of the treadmill until it stops. Let your patient stand static on the treadmill for a moment or two in order to minimize any dizziness.

While these simple tips aren’t groundbreaking, incorporating them into your process can improve the experience for you and your patient. Either way, you’re delivering better quality service to your patients, and that’s what matters.

Is Attenuation Shift an acceptable substitute for Attenuation Correction?

Posted on: 08.04.16

Identifying attenuation in SPECT images is a critical component of reading images with the highest clinical confidence possible. Today, some advanced nuclear cameras offer attenuation correction, which removes body artifacts and ultimately provides more uniform images. Without this feature, however, there is another alternative technique commonly used to identify attenuation.

Attenuation shift is a method which attempts to move the questionable attenuation seen in the images by repositioning the patient (i.e. from supine to prone) in order to validate its representation. The camera itself is not correcting the attenuation. It is the movement of the attenuation in the additional images that attempts to confirm its existence.

Challenges with the shift technique

During imaging, the patient is transitioned from a supine to a prone position. For Myocardial Perfusion Imaging, this changes the position of the diaphragm and the heart in relation to the camera’s detectors. Although attenuation shift is an accepted method, there are some notable challenges with this technique.

Once the patient is repositioned, the attenuation pattern may change, which leads to the question of consistency. It can be a complicated process, requiring the patient to be repositioned for additional images, and the result may not be reliable.

Attenuation exists in all images; it’s simply a question of where it is located. If the additional images show the movement of the attenuation to a different area, the reading physician may assume it is attenuation. However, the potential exists that the attenuator was not able to be moved enough to confidently come to that conclusion. By changing the patient’s position, variability is introduced, which is problematic for the process.

If your camera does not provide attenuation correction, the shift technique is an acceptable option. However attenuation correction is ultimately the best method for optimum clinical confidence and is proven to reduce the number of false positives.

What is nuclear medicine?

Posted on: 07.28.16

Nuclear medicine is a medical specialty that helps physicians diagnose and treat disease by showing how different organs are functioning inside the body. Through the use of radiopharmaceuticals and gamma cameras, physicians can gain valuable medical information and identify issues in the earliest stages of a disease. This insight allows patients to begin treatment earlier, so as to give them the most promising prognosis possible.

How does it work?

A radiopharmaceutical is simply a medicine that is combined with a small quantity of radioactive material, which is designed to highlight a particular part of the body. It involves the ingestion, inhalation, or injection of the radiopharmaceutical, followed by an imaging procedure using a gamma camera. These images record radiation that comes from within the body as opposed to radiation that is sent through the body like X-rays and CT scans. Those tests focus on anatomy and structural appearance of organs, while nuclear medicine procedures focus on organ function.

The technologist who performs the scans and the physicians who supervise the procedure and interpret the results are specially trained and certified in nuclear medicine.

What diseases can be diagnosed?

Nuclear medicine can be used to diagnose many diseases, including those that would typically require exploratory surgery, like lesions located deep inside the body. For example, nuclear medicine testing can be used to determine whether the heart can efficiently pump blood, the brain is receiving enough blood supply, whether organ cells are functioning properly, if kidneys are receiving and filtering blood correctly, or if the stomach is processing food or liquids properly.

Nuclear medicine procedures can determine a patients’ blood volume, lung function, vitamin absorption, and bone density. Images from nuclear medicine can effectively identify sites of epilepsy seizures, Parkinson’s disease, Alzheimer’s disease, or locate cancers. After a heart attack, nuclear imaging can measure the extent of damage to the heart. This imaging modality can also determine how well newly transplanted organs are functioning.

What’s next?

Research in nuclear medicine results in daily advancements and refinement of equipment and procedures. With more than 5,000 nuclear medicine centers in the U.S., performing nearly 18 million procedures every year, Nuclear Medicine continues to be a safe and powerful means of identifying and treating many diseases. Research and development in the field is robust and will likely result in new, novel diagnostic and therapeutic procedures for the benefit of patients worldwide.

Healthcare Quick Links – July 2016

Posted on: 07.21.16

A Look Inside a Beating Heart Cell

You might expect that scientists already know everything there is to know about how a healthy heart beats. But researchers have only recently had the tools to observe some of the dynamic inner workings of heart cells as they beat. Now an NIH-funded team has captured video to show that a component of a heart muscle cell called microtubules—long thought to be very rigid—serve an unexpected role as molecular shock absorbers. Continue reading…

ImageGuide Registry Purpose

It is a clear imperative for the American Society of Nuclear Cardiology (ASNC) and its members to lead a strategy that will drive continuous improvement of nuclear cardiac imaging. The ASNC ImageGuide Registry for cardiovascular imaging data will provide the operational framework to support a community of practices committed to continuous patient-centered imaging, practice transformation, and innovation through ongoing data collection and quality improvement. The ImageGuide Registry will provide data related tools and resources, including the strategic development of educational, quality, and patient safety programs. Continue reading…

Group Practice Reporting Option

In accordance with section 1848(m)(3)(C) of the Social Security Act (the Act), the Centers for Medicare & Medicaid Services (CMS) created a new group practice reporting option (GPRO) for the Physician Quality Reporting System (PQRS) in 2010. Group practices participating in PQRS GPRO that satisfactorily report data on PQRS measures for a particular reporting period may avoid a negative PQRS payment adjustment equal to a specified percentage of the group practice’s total estimated Medicare Part B Physician Fee Schedule (MPFS) allowed charges for covered professional services furnished during the reporting period. Continue reading…

5 Practices That Can Help Health Systems Build Improved Relations With Doctors

Health system executives rank physician alignment as one of their top near-term priorities. As the market shifts toward financial incentives for quality, cost control and experience, closer collaboration between physicians and systems becomes a necessity. So it is not surprising that alignment is a top concern: Even organizations that are primarily focused on fee-for-service strategies are reconsidering physician alignment with an eye on the value-based future. Too many organizations, however, are approaching alignment with outdated strategies and miscalculated priorities. Continue reading…

AATS.16: Cardiothoracic Surgeons Will See a Major Caseload Increases

By 2035, cardiothoracic surgeons will be responsible for more than 850,000 patients, a 61 percent increased caseload overall and a 121 percent increase for each surgeon, according to a database analysis. Lead researcher Susan Moffat-Bruce, MD, PhD, of Ohio State University, presented the results at the American Association for Thoracic Surgery annual meeting in Baltimore. Continue reading…

FDA Approves Blue Earth PET Agent for Prostate Cancer

The U.S. Food and Drug Administration (FDA) has approved a new PET radiopharmaceutical from Blue Earth Diagnostics for detecting recurrent prostate cancer. Called Axumin, the agent is intended for PET imaging of men who are suspected of having recurrent prostate cancer, based on elevated prostate-specific antigen (PSA) levels that occur after primary treatment. Axumin contains a fluciclovine amino acid labeled with an F-18 radioisotope. Continue reading…

Storm Warning: Preparing for a Deluge of Cardiovascular Patients

Physicians and nurses, trained in a variety of cardiovascular specialties and serving different patient populations, worry that a tsunami of patients is not far away. Stroke Nurse Practitioner Amy Nieberlein, who is working on a transition-to-home initiative, worries not just about the “stroke tsunami” that will accompany aging baby boomers but also about “dangerous levels of stress and anxiety” their families and other caregivers will face. Continue reading…

Time to Get Ahead of the Curve: Clinical Decision Support Mandate Delayed, Not Dead

Clinical decision support (CDS) tools have the potential to curb inappropriate imaging, reduce healthcare costs and improve the quality of care, according to data from the small number of early adopters in the United States. These clinicians are a step or two ahead of the Centers for Medicare & Medicaid Services (CMS), which last fall delayed implementation of the provision in the Protecting Access to Medicare Act (PAMA) that requires physicians to use CDS tools, and document their use, whenever they order advanced imaging tests. Cardiovascular Business spoke with physicians who are ahead of the CDS curve and others who are getting ready for its arrival. Continue reading…

Two great events from ASNC this month

Posted on: 07.15.16

If you’re interested in the best practices and latest research available in the field of nuclear cardiology, ASNC is hosting two important webinars. Register and mark your calendars now- these are two events you won’t want to miss.

Reporting a Myocardial Perfusion SPECT Scan
July 20, 9:00 PM PT

On July 20, 2016, the International Atomic Energy Agency (IAEA) and the American Society of Nuclear Cardiology (ASNC) invite you to attend the webinar, Reporting a Myocardial Perfusion SPECT Scan. This is the fourth in a series of complimentary webinars designed to provide cardiologists, radiologists, technologists and nuclear medicine physicians with the best practices in nuclear cardiology.

The guest speaker, Peter Tilkemeier, MD, will discuss SPECT studies, accurate reporting, compliance guidelines, the use of structured data, structured reporting and the important role they play in registries, such as ASNC’s ImageGuide Registry.

The event will begin at 9:00 PM PT and end promptly at 10:00 PM PT. For more details or to register, click here.

Imaging Guidelines/SNMMI Procedure Standard for PET
July 28, 12:00 PM ET

The following week, on July 28, 2016, ASNC will be offering a webinar on the 2016 PET Myocardial Perfusion and Metabolism Clinical Imaging Guidelines. Provided by the American Society of Nuclear Cardiology (ASNC) in collaboration with the Society of Nuclear Medicine and Molecular Imaging (SNMMI), this event will review the application of the newly published guidelines for the performance of nuclear cardiology procedures and will include a 10-15 minute Q & A session to discuss specific issues. It is complimentary for all ASNC members and $75 for all non-members.

The webinar will begin at 12:00 PM ET and end promptly at 1:00 PM ET. Your participation is also eligible for continuing education credits so please be sure to review the requirements.

For more information or to register for this event, click here.

Improving Sensitivity and Specificity with Attenuation Correction

Posted on: 07.07.16

Sensitivity and specificity are statistical measures of the performance of a diagnostic imaging test. Sensitivity, which is also referred to as the true positive rate, is a proportionate measure of patients who are accurately identified as having a specific condition.

Conversely, specificity, also called the true negative rate, measures the proportion of patients who are accurately identified as not having the same condition. In other words, sensitivity quantifies the avoidance of false negatives as specificity does the same for false positives.

How does attenuation correction help?

Attenuation correction is a major contributor to both specificity and sensitivity. By reducing attenuation, the images will be more uniform, allow for higher reading and diagnostic confidence and help decrease the likelihood of false positives. It offers greater support to the reading physician that normal is indeed normal, without question.

The immeasurable value of attenuation correction is the reduced number of patients who could potentially undergo additional unnecessary procedures because their images were inconclusive or indicated a positive result, albeit false. Ultimately, the optimized specificity brought about through attenuation correction should not be discounted. It is the most accurate way to get a “normal” scan.

In the gradual shift toward stress-only Myocardial Perfusion Imaging protocols, specificity leads to greater accuracy, substantially impacts patient care and the growing concern surrounding radiation burden. Attenuation correction can positively influence all of these aspects.

Digirad adds QuantumCam to camera line-up

Posted on: 06.30.16

Digirad has expanded its offerings as a nuclear medicine company by adding a variable angle camera to its growing array of high-quality imaging equipment. Through their relationship with Universal Medical Resources, Inc., the exclusive North America distributor for DDD Diagnostic, Digirad has added the CorCam™ and QuantumCam™ cameras to its product catalog.

QuantumCam variable angle imaging system

QuantumCam is a dual detector, variable angle, total body, SPECT and general purpose nuclear imaging system. It offers a large field-of-view and delivers all the flexibility you would expect from a variable angle camera. QuantumCam has the ability to perform total body scans, bone SPECTs, planar imaging, and cardiac imaging in the 90-degree mode. With its highly flexible detector positioning, and open gantry, non-claustrophobic design, it allows for ease-of-use and greater patient comfort.

Compared to other SPECT cameras on the market, the QuantumCam has lower acquisition and ownership costs, a smaller footprint and higher imaging quality. “It’s hard to find all these attributes in one device,” says Jason Kitchell, Chief Operating Officer at Universal.

DDD Diagnostic

DDD is a highly reputable company with extensive experience developing and manufacturing gamma cameras and gamma products. They have been a long-term provider in the nuclear medicine industry and are a major supplier for GE, Phillips, and Siemens. You’ll surely recognize their products, even if you don’t recognize their name.

Partnering for customer success

Digirad is in the business of providing the best, most cost-effective solution that meets a customer’s specific needs. By expanding their product options to include a variable angle camera, Digirad offers a more comprehensive selection and, thereby, better serves their customers. Digirad is looking forward to growing their relationship with Universal and bringing the benefits of the QuantumCam to the market.

5 mistakes that practices make when choosing a mobile imaging provider

Posted on: 06.23.16

Choosing a mobile imaging provider could be one of the best decisions you’ll make for your practice. As an extension of your staff, your services partner will be a direct reflection of the quality of service you provide, your level of professionalism, and the quality of your medical services. With all that at stake, here are 5 mistakes you want to avoid when choosing a provider.

1. Choosing a provider with old and outdated equipment

One key advantage of mobile imaging is access to the most current technology and protocols without the initial outlay of capital. Outdated equipment will affect your patients and your profitability. An old or outdated camera and/or outdated software can result in poor quality images, reduced clinical confidence, and damage to the quality of the service you provide. Offering nuclear imaging at your location should increase the perceived sophistication of your practice. Why dampen that with inferior equipment?

Additionally, consider the accessibility of replacement parts should the camera be in need of repair. How much time could the provider’s camera be out of commission if parts are not readily available, and how could that impact your scheduled service day? Today’s healthcare environment mandates quality and accuracy; risking false positive studies with outdated equipment or software is not acceptable.

2. Choosing a partner with a small infrastructure

How large is the size of the provider’s fleet? Do they have enough equipment to support their customers’ needs, plus some? Will they have a replacement camera available if another is unexpectedly in need of repair? Do they have enough employees to address the ongoing needs of sick days, vacation days, leaves of absence or employee emergencies? You need to have confidence that your mobile imaging provider will arrive and be ready to see patients on their scheduled service day, regardless of any challenges they experience along the way.

3. Choosing a provider solely based on price

A quality mobile imaging provider should structure your relationship to make your service days profitable. Some practices try to maximize their profit by choosing a provider who offers their services at the lowest cost. While the least expensive service may economically seem like the best choice, be sure to consider the whole picture. If a provider is cutting corners, it will be reflected in the quality of their service, potentially resulting in excessive false positive studies. This negatively impacts your patients and your practice’s reputation with referring physicians. Don’t be afraid to ask a low-cost provider how they are able to offer their services at such price points and still provide high quality studies with the best possible patient outcomes. If a prospective service partner is significantly lower than others, there is likely a reason, and it will end up costing you in the long run.

4. Choosing a partner without supporting services

Partnering with a mobile imaging provider should help take the burden of responsibility away from you and your staff, not add to it. An ideal service should provide all credentialing, accreditation, equipment with the latest technology and software, qualified staff, supplies, study pre-certification, online PACS access, and unlimited billing and coding support. Additionally, the equipment used by the service partner should be under continuous Repair and Maintenance service with a nationally reputable camera support and service provider. When you partner with a mobile imaging services company, the objective is for them to manage all aspects of the additional service so that you can focus on practicing medicine.

5. Unknowingly choosing a provider with illegal or fraudulent practices

Even though your imaging provider is a separate entity, when you hire them, you are responsible for their actions and behavior. It’s important to be well versed in the billing process and the exact terms of your contract. Be continuously aware and thorough in your understanding and agreement. It is also important to understand that the Federal Government holds you and your practice accountable for HIPAA compliance and the HIPAA compliance program of your service partner. Ignorance will not exempt you from the legal consequences of fraudulent and unethical practices.

Key differences between Holter Monitors and Telemetry

Posted on: 06.16.16

Monitoring Period

A Holter monitor typically records cardiac activity for an uninterrupted 24-48 hours, although some are prescribed for up to 14 days. It is ideal for the patient who is experiencing symptoms on a more frequent or regular basis and whose condition does not require continuous monitoring.

Mobile cardiac telemetry is prescribed for a period up to 30 days. It is typically prescribed for patients with rare or intermittent episodes, or those who may be asymptomatic. The extended wear time allows for the opportunity to capture an arrhythmia that may not occur during a shortened wear time and is also helpful in identifying a silent pattern of irregular cardiac activity.

Recording Methods

Holter monitors are designed to continuously record data. While their limited wear time reduces the inconvenience for patients, it’s also one of the reasons a Holter may be returned as non-diagnostic, or benign. Most often, this is because symptoms may not reappear during the time in which the Holter is monitoring the patient’s heart rhythm.

Telemetry devices offer a variety of recording methods. Many MCT devices are continually listening, recording every heartbeat for up to 30 days, and provide atrial fibrillation burden assessment.

Data Storage

Devices can store their data either locally or in the cloud. The data collected from a Holter monitor is stored on an internal chip and is limited in terms of space, but sufficient for the prescribed wear time.

Telemetry device storage varies. It can be stored locally or transmit the information to the cloud, as long as there is a strong cell signal present. This feature is significant because the data can be read in real time and irregularities can be addressed immediately. This difference is especially prominent when compared to the 7-14 day Holter monitors. Any irregularity identified with a Holter monitor will not be read until the monitor is returned and analyzed at the end of the prescribed wear time, which could potentially be up to 20 days later.

Device Differences

Both Holter monitors and telemetry devices require leads that are attached to the patient. Holter monitors typically require more leads and tend to be more bulky. As a result of the technology it uses, a telemetry device is smaller, sleeker and easier to wear.

There are also differences in the ways the devices are powered. Based on the amount of wear time, Holter monitors may have batteries that need to be changed. Newer telemetry device models are rechargeable. They typically include two batteries, one to wear while the other is charging.

Depending upon your symptoms, or lack thereof, your physician will prescribe the appropriate monitoring device. Both are completely painless and are considered highly effective ways to identify potential heart issues and to help determine the appropriate treatment.

Benefits of upright imaging

Posted on: 06.09.16

Traditionally, patients undergoing SPECT Myocardial Perfusion Imaging (MPI) were imaged in the supine position. Although convenient from a procedural standpoint, patient experience and satisfaction may be significantly enhanced through upright imaging. As the technology, image quality, and clinical confidence have continued to improve, upright imaging is gaining more attention and consideration among physicians and technologists.

Supine vs. Upright Imaging

With supine imaging, patients must climb up to, and position themselves on, a roughly 15-24” imaging table. Face-up, they lie still with their arms raised above their heads, which can be difficult or uncomfortable for some, especially those patients with COPD, arthritis or other shoulder or arm impediments. The size and the location of the camera detectors also have the potential to exacerbate any feelings of claustrophobia since they rotate so closely around the patient’s face or chin.

The general consensus among patients is that if you can comfortably get in and out of your car, you can get up and down from an upright imaging scan. Across several formal and informal surveys, the overwhelming majority of patients preferred upright, seated imaging. The patient’s arms rest easily on the device’s armrest, which alleviates the need for the patient to stabilize that overhead weight. The seated position is easy to navigate, and the more compact detectors are much less imposing, which offers a significant improvement in comfort and patient anxiety.

Which is a better choice?

Clinically, choosing one position over the other does not impact the imaging results or the physician’s diagnostic confidence. The preference revolves around comfort and ease of use from both the patient and the technologist’s perspective. In today’s healthcare marketplace, where quality of service can be directly correlated with patient satisfaction, retention, and referrals, upright Myocardial Perfusion Imaging is gaining support in the broader imaging community.

June Healthcare News Update

Posted on: 06.02.16

The Latest CMS Proposed Rule and its Impact on Hospitals’ Cardiovascular Business

CMS recently released the Fiscal Year 2017 (FY17) Proposed Inpatient Rule, which outlines the proposed requirements and payment changes that will go into effect October 1, 2016. Cardiovascular related services continue to play a significant role in terms of inpatient volumes. Additionally, these services represent an area of important focus as clinical quality and outcome requirements impacting payment penalties continue to grow. Read more…

Will Medicare’s Physician Payment Overhaul Drive More Docs to Hospitals?

The CMS began to answer some of the many questions about how physicians will get paid under the Medicare Access and CHIP Reauthorization Act. But some stakeholders were immediately dissatisfied with what they saw, and the 963-page rule may have raised as many questions as it answered. The rule did provide more clarity around the CMS’ proposed Quality Payment Program. Read more…

ASNC Imaging Guidelines for SPECT

New guidelines published by ASNC provide nuclear cardiologists, nuclear medicine physicians, radiologists, physicians-in-training, nuclear technologists and other clinicians who perform nuclear cardiology SPECT procedures with a comprehensive resource detailing the latest imaging technology developments, stress modality advances, updated radiotracer dosing recommendations and, for the first time, recommendations for I123 MIBG imaging. Published online ahead of print in the Journal of Nuclear Cardiology (JNC), the new guideline, “ASNC Imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers,” features more than 20 detailed illustrations and tables ideal for posting in nuclear cardiology laboratories. View and download all of our guidelines.

Joint Commission Ends Text Messaging Ban for Clinicians

The Joint Commission is ending its five-year-old ban on text messaging. Effective immediately, “licensed independent practitioners or other practitioners in accordance with professional standards of practice, law and regulation and policies and procedures may text orders as long as a secure text messaging platform is used and the required components of an order are included,” the commission announced in its May 2016 Perspectives newsletter. Read more…

Comparing Advancing Care Information to Meaningful Use

In a recent fact sheet, CMS details the Advancing Care Information program and how it could be used to assess value-based care for office-based physicians and other clinicians in the Merit-Based Incentive Payment System (MIPS). Under the notice of proposed rulemaking for MACRA implementation, the Advancing Care Information program would replace meaningful use in efforts to realign Medicare payments with patient-centered, quality care. It is designed to provide more flexibility for physicians when it comes to reporting quality care and certified EHR use. Read more…

Cardiologist Details Potential Benefits of MACRA

Since the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) passed last spring, cardiologists and other providers have wondered how the legislation would change their reimbursement for treating Medicare patients. Matthew Phillips, MD, FACC, the governor the American College of Cardiology’s (ACC’s) Texas chapter from 2013 to 2016, is one renowned cardiologist who is embracing the change. He wrote an editorial online in the Journal of the American College of Cardiology expressing his optimism about MACRA. Read more…

Hopkins: ‘Cascading Accountability’ Boosts Ambulatory Quality, Safety

“Hopkins has always had an emphasis on quality and safety that was really borne from our inpatient experiences,” says Steven Kravet, MD, president of Baltimore, MD-based Johns Hopkins Community Physicians. Yet how will they ensure that the quality of care remains high, even as the organization grows? JHM recognized the need for better ambulatory quality and safety processes to maintain the high-level of care that’s become the inpatient standard. So it developed a model to coordinate high-quality care across its ambulatory care centers. Read more…

New CMS Primary-care Payment Model Would Affect 20K Doctors

The CMS wants to pay practices a monthly fee to manage care for as many as 25 million patients in the agency’s largest-ever plan to transform and improve how primary care is delivered and reimbursed. The Comprehensive Primary Care Plus initiative will be implemented in up to 20 regions and include up to 5,000 practices, which would encompass more than 20,000 doctors and clinicians. The program would collaborate with commercial, state, and other federal insurance plans. Read more…

ACC.16: FDA Commissioner Discusses Evidence-based Medicine, Changing Healthcare Industry

FDA commissioner Robert M. Califf, MD, stressed the importance of relying on data and evidence when approving medications and creating guidelines during a session at the ACC scientific session on April 4, 2016. Califf defined evidence-based practice as the integration of clinical expertise, patient values and the best research evidence into the decision making for patient care. He said FDA labels and ACC/American Heart Association (AHA) clinical practice guidelines should serve as the foundations for evidence-based medicine. Read more…

Visit Digirad at the 2016 SNMMI Annual Meeting

Posted on: 05.26.16

The Society of Nuclear Medicine and Molecular Imaging (SNMMI) Annual Meeting is considered the premier educational, scientific, research, and networking event in nuclear medicine and molecular imaging. The 2016 meeting will be held at the San Diego Convention Center in sunny San Diego, California from June 11-15. This highly anticipated event provides physicians, technologists, pharmacists, laboratory professionals, and scientists with an in-depth view of the latest technologies and research in the field.

The world’s largest event focused exclusively on the educational and networking needs of the nuclear medicine and molecular imaging community, SNMMI’s Annual Meeting will host 3,600+ industry professionals from across the globe. Among other educational opportunities, it will feature more than 150 scientific and CE sessions and 1,000+ scientific posters. The world-class Exhibit Hall will showcase the industry’s leading suppliers and offer attendees the opportunity to witness ground-breaking new products and services and interact with the vendors who use the latest advancements in technology to drive innovation and growth.

Digirad is proud to be exhibiting our Cardius® X-ACT and Ergo™ Imaging System at the 2016 SNMMI Annual Meeting. You can find us at Booth #1631.Be sure to stop by and see us! Click here to view the exhibit map.

What is solid state nuclear imaging?

Posted on: 05.19.16

The term “solid-state” has been used in medical imaging for years, but what does it really mean? As a leading producer of solid-state nuclear cameras, Digirad is here to explain what makes a camera solid-state.

Pixilated crystals and speed

With solid-state technology, the camera detectors are comprised of thousands of individual detector elements, not a solid sheet of crystal and large photomultiplier tubes (PMTs) found in Anger cameras. Each solid-state detector element (pixel) is isolated from one another. When a scintillation event occurs on a particular crystal, its exact location can be quickly and correctly identified, making the detector substantially faster and more accurate.

Pixilated detectors also eliminate the need for time-consuming summing algorithms used in Anger technology. Scatter correction can be performed more quickly because the system is not spending an excessive amount of computer and electronic time trying to determine the location of the event.

Solid-state pixilated detectors eliminate issues related to linearity and summing, allowing a much simpler methodology with increased reliability. Solid-state technology also allows for lower levels of radiation to be used in imaging. Also, with solid-state imaging, attenuation correction can be performed using the same detectors for both the transmission and emission in a single sitting.

Direct and indirect conversion

There are two primary conversion methods for solid-state nuclear imaging; direct and indirect. Each conversion method is different, but both create increased reading confidence and an improved patient experience.

Direct conversion uses cadmium zinc telluride (CZT). When a photon is absorbed by the crystal, it creates an electric charge directly, hence the term direct conversion. Direct conversion is effective; however the manufacturing cost of CZT can be expensive.

Indirect conversion uses a silicon-based photodiode, coupled with cesium iodide (CsI) crystal material. When a photon comes in contact with the crystal, it produces light, which is converted to an electronic signal. This process is faster, and manufacturing cost of CsI detectors is much less than CZT.

Solid-state nuclear cameras offer significant advantages over Anger-based cameras. This state-of-the-art technology continues to revolutionize nuclear imaging and provide patients with the highest level of diagnostic confidence.

Common Questions About Mobile Imaging

Posted on: 05.12.16

How many patients do I need for mobile imaging to make sense?

Generally, one service day per month, with six patients per day, is considered reasonable. More patients allow for greater profitability. If there are fewer than four patients in a day, it may be difficult to justify the economics. Much of what determines your breakeven point is determined by the terms of the contract. Structure the relationship so that your breakeven point is modest compared to the number of tests you can perform in a single day, thereby ensuring profitability.

What are the upfront costs for mobile imaging?

There should be no, or very little, upfront costs for mobile imaging. The whole purpose of mobile imaging is to provide a practice with an imaging solution without the initial capital and overhead expenditures. The provider you choose should be responsible for the credentialing, accreditation, equipment, staffing, supplies, HIPAA compliance, billing and coding support.

I am not an authorized user; can I still offer mobile nuclear imaging?

Yes. You do not need to be board-certified in nuclear cardiology to take advantage of a mobile imaging service. Your mobile imaging provider can assist with all related licensing requirements and put you in contact with an authorized user to read your patients’ images.

How much space do I need?

One standard size exam room will sufficiently serve as the location for your imaging services. The imaging staff will use the room for the day, set up the equipment, image patients, and return the room to its original configuration at the end of the day.

Will offering nuclear imaging cut down on the number of echos?

By offering both modalities in your office, you’ll be more inclined to choose the right test for the right patient at the right time. Initially, you may see some shift from echo to nuclear, but over time, you may be doing the same number of echos and more nuclears. You’ll feel more comfortable and confident that you’re making the right recommendation because both are conveniently available and easily accessible.

Who will be providing the imaging?

While we can’t speak for the entire industry, Digirad hires only qualified nuclear medicine technologists who are certified by NMTCB or ARRT(N) and certified cardiovascular technicians. We provide references and license verification for each of our personnel. These highly technical professionals also undergo a thorough screening process. They integrate themselves with your practice and procedures to become an asset and contribute to the overall success of your business.

How much does mobile nuclear imaging cost?

The honest answer is that it will vary. The cost of your mobile imaging service should be structured in such a way that every service day results in a profit for your practice. The level of profitability will depend upon the unique needs of your practice: your clinical volume, the frequency of service days, the studies you perform and your office location. The margin between your set mobile imaging cost and the fee billed to payers will allow you to calculate your profitability in advance.

Is mobile nuclear imaging equipment as good as what patients would get in the hospital?

Yes. Digirad’s Cardius® imaging cameras use digital solid-state technology that is more advanced than many cameras in the market. The images that mobile cameras produce are of equal, or often better, quality to the images produced by stationary or fixed camera systems. The Cardius® features include:

Solid State Flat Panel Detectors
Compact, Open Design
TruACQ™ Count-Based Imaging
nSPEED™ 3D OSEM Reconstruction
Imaging Capacity of Patients up to 500 pounds

Have a question not on this list? Let us know and we can get you an answer.

Cardiac Monitoring Service: Do cardiac trained RNs make a difference?

Posted on: 05.05.16

While there are many variables to consider when partnering with a cardiac monitoring service, the reading expertise of the clinical staff is one of the most important.

Cardiac monitoring services that employ registered nurses offer an undeniably higher level of readiness to their customers and their patients. Their expertise allows them to serve as an extension of the physician as they ask critical questions, provide comprehensive care, and a more holistic approach.

In many cases, seasoned registered nurses, leveraging their experience, has been instrumental in identifying subtle but serious signs that may have easily been overlooked.

Preventing unnecessary procedures

For example, a particular case reported a patient was presenting a complete heart block, which was clearly cause to notify the physician. The patient was immediately directed to the emergency room in anticipation of surgery to implant a pacemaker.

A monitoring staff nurse who was familiar with this particular patient noticed that he had taken a double dose of a calcium channel blocker that works by relaxing the muscles of the heart and blood vessels. She notified the physician, who cancelled his prior instruction for the patient to head to the emergency room and instead, discontinued the medication. The next day, the patient returned to normal sinus rhythm.

This example was a situation where the nurse was able to provide information that helped prevent unnecessary treatment. In other instances, registered nurses are able to identify arrhythmias and triage patients who required an implantable device or other treatment, potentially eliminating an emergency response. Their expertise works both ways and across the full spectrum of care.

A full spectrum of benefits

In addition to the health considerations, the nurse who noticed the double dose of medication prevented a costly hospital visit for the patient. Even with health insurance, the patient would have most likely incurred a copayment, and the healthcare system would have incurred an unnecessary cost as well.

Most of the interactions between patients and the monitoring service take place over the phone. Cardiac trained nurses are experts at listening for shortness of breath, difficulty talking, wheezing, rales and other signs that are not instantly visible on an electrocardiogram. Combining what they can see on an EKG with the information they gain while talking to a patient can make all the difference.

All notifications from a monitoring service are potentially life saving. Given the critical nature of the data, a registered nurse who can more easily piece together a patient’s story, process it, and act quickly on that data is the highest level of care a monitoring service can provide.

May Healthcare News Update

Posted on: 05.03.16

Age-adjusted heart failure-related deaths increase from 2012 to 2014

After declining for more than a decade, the age-adjusted rate for heart failure-related deaths increased from 2012 to 2014, according to a recent data brief from the National Center for Health Statistics. The trend was consistent for men and women of all age groups studied: 45 to 64 years old; 65 to 74 years old; 75 to 84 years old; and 85 and older. The death rate was higher for men than for women in all age groups. Read more…

ASNC Leadership on the Hill discuss AUC mandate

On February 8, 2016 members of ASNC’s Executive Council and Health Policy Committee attended 35 meetings with members of Congress and their staff to express ongoing concerns about the successful implementation of the AUC mandate (§ 218 of the Protecting Access to Medicare Act of 2014). Specifically, the group requested report language that would urge HHS to leverage existing resources and foster collaboration across agencies to ensure knowledge gaps referring physicians may have in using AUC for advanced imaging services can be addressed prior to PAMA implementation. Read more…

Seven easy ways to reduce heart disease risk and be heart-healthy

It’s no secret that heart disease is the leading cause of death for adult men and women in this country. It kills one of every four people. The American Heart Association recommends seven easy ways to reduce your risk for heart disease and be heart-healthy. The AHA calls them, “Life’s Simple 7,” because they are easy to understand and can be followed by anyone at any age. Read more…

ACC releases lifelong learning competencies document for cardiologists

The American College of Cardiology (ACC) competency management committee released a report outlining competencies cardiologists should develop during their careers. The document, 2016 ACC Lifelong Learning Competencies for General Cardiologists, organizes the competencies based on six domains that the Accreditation Council for Graduate Medical Education and American Board of Medical Specialties developed. The American Board of Internal Medicine (ABIM) also endorsed the six domains. Read more…

Obama administration backs off on ACA rules for 2017 health plans

In a major win for the industry, health insurers will not be forced to have minimum quantitative standards when designing their networks of hospitals and doctors for 2017, nor will they have to offer standardized options for health plans. The CMS release a sweeping final rule that solidifies the Affordable Care Act’s coverage policies for 2017. The agency proposed tight network adequacy provisions and standardized health plan options in November, which fueled antipathy from the health insurance industry. Read more…

Senate confirms cardiologist as FDA head: 3 things to know

Robert Califf, MD, a cardiologist and clinical researcher from Durham, N.C.-based Duke University, was confirmed by the U.S. Senate Feb. 24 as the next commissioner of the Food and Drug Administration, according to a report from The New York Times. Dr. Califf joined the FDA as deputy commissioner last year from Duke University, where he had served as a professor of medicine, a leading pharmaceutical researcher and the vice chancellor for clinical and translational research. Read more…

ASNC Appropriate Use Satellite Symposium

Posted on: 04.29.16

ASNC will be hosting a satellite symposium at the American College of Physicians annual meeting on May 3, 2016. This Satellite Symposium is a part of ASNC’s initiative to promote appropriate use criteria to the referring community and will increase learners’ competence in choosing the appropriate test in the appropriate patient.

Participants will learn about current roles and applications of the appropriate use of nuclear cardiac imaging studies, application of appropriate use criteria, and guidelines when referring patients for nuclear cardiology studies.

Event Details

Appropriate Use of Nuclear Cardiology in Clinical Practice
Tuesday, May 3, 2016
12:15 pm to 1:15 pm
Salon ABC, Walter Washington Convention Center
Washington, DC

Click here to register or learn more

ASNC designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™.

What is a Stress-Only Protocol?

Posted on: 04.28.16

Stress-only protocol is the directive by which a medical provider performs a cardiac stress test without the complementary resting scan. Traditionally, both a resting scan and a stress scan are performed on patients, which are then compared to more confidently support a diagnosis. Often, what could potentially be an abnormality in one image is disproved by the other, thereby reducing inaccurate conclusions. It does, however, subject the patient to two radiation doses, sometimes unnecessarily.

How it works

Once the stress scan is complete, the patient waits for the reading physician to review the results. If the recommendation is to perform an additional resting scan, it can be carried out without any delay.

In an alternate scenario, once the stress scan is complete, the patient may leave the office. Should the reading physician review the results and recommend the resting scan, the patient can return the following day, or shortly after that to complete the process.

Regardless of the logistics, the stress-only protocol can potentially spare your patient an added radiation burden. With that, there are some practical challenges that need consideration, such as the accessibility of the reading physician, clinical confidence in interpreting a low-dose stress-only study, and the flexible scheduling component.

ASNC recommendation

The American Society of Nuclear Cardiology supports the stress-only protocol in low to moderate risk patients and recommends using attenuation correction, if possible. With the reduced attenuation, the images will be more uniform and allow for higher reading and diagnostic confidence.

By helping to deliver the most accurate depiction as possible, the improved image clarity provided by attenuation correction increases the likelihood of achieving the ultimate goal of the stress-only protocol, avoiding an additional study that increases a patient’s radiation burden unnecessarily.

Heart Rhythm Society Annual Scientific Sessions

Posted on: 04.26.16

The Heart Rhythm Society’s 37th Annual Scientific Sessions will be held May 4-7 at the Moscone Center in sunny San Francisco, California. Over the course of four days, more than 900 noted heart rhythm experts will speak at 250+ educational sessions designed to provide practical information and best practices for physicians, allied health professionals, and scientists. Attendees will have the opportunity to immerse themselves in a global community of professionals dedicated to improving the care of patients with heart rhythm disorders.

The Exhibit Hall, which will feature more than 130 exhibitors, will showcase a broad range of educational opportunities, practice solutions, and innovations to enhance patient care and will display and demonstrate the latest arrhythmia products and services. Additionally, in the Epicenter, attendees will have the opportunity for interactive learning, discovery and networking with industry leaders.

New developments at ASNC, an interview with Kathy Flood

Posted on: 04.21.16

The American Society of Nuclear Cardiology (ASNC) is the leader in quality, education, advocacy and standards in cardiovascular imaging. Digirad had the privilege of sitting down with Kathy Flood, Chief Executive Officer of ASNC, to discuss some of the new developments and initiatives they have underway.

Image Guide Registry

Officially launched in February 2016, the ImageGuide Registry is the first cardiac imaging registry in the country. The Medicare-approved registry is a collection of foundational elements that comprise a quality nuclear cardiology practice. Physicians will be able to submit data through the reporting software and then, in real time, will be able to access their profile and mark their performance against 22 quality measures.

The primary goal of the ImageGuide Registry is to provide a tool that helps to continuously improve the quality of a physician’s practice. Secondarily, it will allow physicians to participate in the Medicare PQRS programs, and beginning in 2018, the new Medicare MIPS program that will seek quality data from registries. “ASNC is working to be a solution for physicians and industry partners by ensuring they have all the support they need to succeed,” Flood said.

Educating our referring physicians

Another ASNC priority this year is the plan to educate referring physicians. With two efforts already underway, ASNC wants to communicate the value of nuclear cardiology and when it is appropriate to refer a patient. Flood said, “Our goal is to have referring physicians consider the right test for the patient. Ensuring they understand the of value of nuclear cardiac testing is important to determine when a referral is appropriate, which will help improve rates of appropriate imaging.”

ASNC is also working to develop an online resource center in conjunction with the American College of Physicians. These resources will address nuclear cardiology imaging, appropriate use, when to prescribe the test, and questions to ask patients. “This information is so important, especially with the increased scrutiny around any advanced imaging orders, not just cardiology. We want to make sure our referring colleagues are well informed to make the right decisions for patients,” said Flood.

The initiatives that ASNC is spearheading clearly demonstrate their commitment to the quality improvement, education and support of their members and the nuclear cardiology community. For more information on these efforts, other events, and educational resources, visit their website.

Section 179 Tax Savings for Medical Equipment

Posted on: 04.14.16

What is Section 179?

Section 179 allows business owners to deduct the full purchase price of qualifying equipment and software that was purchased or financed during the tax year, rather than depreciating it over the asset’s useful life. This much-needed tax relief may be the motivation to buy equipment sooner than later and ultimately help grow your practice. When considering a significant purchase, the Section 179 tax break could be the opportunity for many physicians to purchase or upgrade equipment, offer new services, or open a new office.

How does it work?

If, during a specific tax year, your practice purchases, finances or leases less than $2 million in new or used equipment, and puts it to use by December 31 of the same year, you should qualify for the deduction. Equipment can include machinery, computers, software, office furniture, vehicles, or other tangible goods.

Specifically created for the benefit of small business, Section 179 also comes with some protective margins. For 2016, a maximum of $500,000 can be written off and the total equipment purchased for the year must be less than $2 million. Once you reach the $2 million mark, the deduction allowance decreases. In order to take full advantage of the tax break, it’s important to stay within the guardrails.

Section 179 also includes a 50% bonus depreciation for 2016, which may or may not be offered in future years. This depreciation is generally taken after the spending cap is reached and is available for new equipment only.

Make your move

Keep in mind that the tax code is never set in stone, and can be amended or repealed each year. If you are considering the purchase or upgrade of your nuclear imaging equipment, Digirad’s nuclear gamma cameras qualify for the generous Section 179 tax treatment. For more information on Section 179, including a list of qualifying items, an illustrated calculation example, and an interactive tax deduction calculator, visit the official website.

ASNC Nuclear Cardiology Today Show Preview

Posted on: 04.07.16

The American Society of Nuclear Cardiology (ASNC) will hold its highly anticipated Nuclear Cardiology Today: A Comprehensive Review & Update program from April 29 – May 1, 2016. Cardiologists, nuclear medicine physicians, nuclear technologists, radiologists, and other nuclear cardiology professionals will gather in Chicago, Illinois to address the leading clinical and practical management issues facing cardiology imaging professionals today.

Why Should I Attend?

This year’s program will not only focus on the new and exciting applications in nuclear cardiology, but it will also offer a record number of practical presentations on SPECT, PET & CT technology, radiation dose, and challenging cases. The knowledge and practical takeaways from these demonstrations will substantially help to raise the quality of imaging studies and help physicians to deliver the best care for their patients.

A number of sessions will also address health policy issues, which may be of special interest to practice administrators. The program’s format will be predominantly speaker-led, but audience engagement will be highly encouraged through Q&A. It will be valuable and well- spent time away from your practice.

Continuing Education

The program content also qualifies for continuing education credit. With scheduling challenges, additional cost, and sometimes limited availability of qualifying instruction, satisfying the requirements of the regulatory world is particularly important for both technologists and physicians, especially in light of the new regulatory mandates.

Digirad is proud to be among the exhibitors at this year’s program. Look for us and our Cardius® 3XPO in the Exhibit Hall. For more information on the program, visit the ASNC website.

March Healthcare News Update

Posted on: 03.31.16

ICDs are associated with improved survival in older adults with heart failure

Adults with heart failure who received implantable cardioverter defibrillators (ICDs) for primary prevention had a significant survival advantage compared with those who did not receive ICDs, according to a propensity score-matched analysis of Medicare patients. After three years of follow-up, the mortality rates were 40.2 percent among women who received an ICD and 48.7 percent among women who did not receive an ICD. Meanwhile, the mortality rates were 43.3 percent among men who received an ICD and 50.9 percent among men who did not receive an ICD. Continue reading…

Bradycardia may not be associated with an increased risk of cardiovascular disease or mortality

After adjusting for risk factors and potential confounders, researchers found that bradycardia was not associated with an increased risk for cardiovascular disease or mortality, according to a retrospective analysis. They defined bradycardia as a heart rate of less than 50 beats per minute and said the condition is typically found in athletic adults. Lead researcher Ajay Dharod, MD, of the Wake Forest School of Medicine in Winston Salem, North Carolina, and colleagues published their results online in JAMA: Internal Medicine on Jan. 19. Continue reading…

Irregular Heart Beat May Pose Bigger Threat to Women

The world’s most common type of abnormal heart rhythm appears to pose a greater health threat to women than men, a new review suggests. Atrial fibrillation is a stronger risk factor for stroke, heart disease, heart failure and death in women than it is in men, according to an analysis published online Jan. 19 in the BMJ. The condition is most often associated with an increased risk of stroke, because the irregular rhythm allows blood to pool and clot in the atria. But women with atrial fibrillation are twice as likely to suffer a stroke than men with the condition are, researchers concluded after reviewing evidence from 30 studies involving 4.3 million patients. Continue reading…

A woman’s heart attack causes, symptoms may differ from a man’s

A woman’s heart attack may have different underlying causes, symptoms and outcomes compared to men, and differences in risk factors and outcomes are further pronounced in black and Hispanic women, according to a scientific statement published in the American Heart Association’s journal Circulation. The statement is the first scientific statement from the American Heart Association on heart attacks in women. It notes that there have been dramatic declines in cardiovascular deaths among women due to improved treatment and prevention of heart disease as well as increased public awareness. Continue reading…

Cardiologist recommends EKG screening for some college athletes

LAST March, the N.C. A.A.’s chief medical officer, Brian Hainline, announced that he was going to recommend that all male college basketball players undergo an electrocardiogram, which measures the electrical activity in the heart, presumably as a requirement for being cleared to play competitively. He said his action was in response to research suggesting that the risk of sudden cardiac death in Division I basketball players was about one in 5,200 per year, much higher than previously thought. Continue reading…

Proposed CMS rule encourages analysis, sharing of medical-claims data

Some medical data miners may soon be allowed to share and sell Medicare and private-sector medical-claims data, as well as analyses of that data, under proposed regulations the CMS issued Friday, January 29. Quality improvement organizations and other “qualified entities” would be granted permission to perform data analytics work and share it with, or sell it to others, under an 86 page proposed rule that carries out a provision of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Continue reading…

Medaxiom Spring Conference Preview

Posted on: 03.24.16

MedAxiom’s annual CV TransForum Conference will be held in sunny Ponte Vedra, Florida from April 7 – 9, 2016. Each year, this premier event gathers industry leaders together to exchange information, share experiences, network with their peers, and discuss industry trends, practical business applications, and best practices.

Representing hundreds of programs from across the country, the cardiovascular community conference will introduce you to executives, consultants, and other professionals. Attendees will learn about some remarkable transformational programs and hear from the nation’s top leaders. They’ll share their advice on how to stay ahead of the curve in today’s ever-changing and complex healthcare environment.

This year’s itinerary includes noteworthy and well-timed general session topics, detailed breakout presentations and more intimate group discussions. From the big picture to deep dive dialogues, attendees will have a variety of opportunities to gain in-depth insight and real-world solutions for the challenges experienced individually and as an industry.

If you’re a hospital or service line administrator, physician leader, CFO, COO or a technologist, you won’t want to miss this opportunity. Digirad is proud to be an exhibitor at the 2016 Transformation Conference again this year. To learn more about MedAxiom and upcoming events, visit their website.

How does a cardiac monitoring service work?

Posted on: 03.16.16

Cardiac monitoring providers offer physicians a way to measure a patient’s heart rhythm over a defined period of time. It is considered standard practice in diagnosing cardiac arrhythmias and is also helpful in evaluating and managing medications and their effect on a patient’s condition.

Monitoring services

Many cardiology practices choose to partner with a monitoring service center that provides equipment, supplies, and reviews EKG data. These companies actively monitor patients that are enrolled in the service and report the results to the doctor for a diagnosis. Patients enrolled in the service are typically experiencing palpitations, atrial fibrillation, atrial flutter, syncope, or a host of other heart rhythm abnormalities

Event monitoring

When a patient is wearing a mobile cardiac telemetry device, the monitoring service continuously receives and observes the patient’s electrocardiogram. If any abnormality presents itself, the monitoring clinician will alert the physician in accordance with the signed notification criteria. A signed notification criteria is a physician-signed notification statement that details the type and level of irregularity and the protocol used to address it.

When a patient has an episode that meets the notification criteria, whether the patient records it or it is automatically recorded via the auto trigger feature of the device, a clinician immediately processes the information and contacts the physician for further instruction. Those further instructions may include heading to the emergency room, the doctor’s office, or a simple adjustment to the patient’s medication.

Holter monitoring

Holter monitors typically store recorded electrocardiogram data within the device and are not evaluated until the prescribed wear-time has expired. Patients return the Holter monitor to the clinic or the doctor’s office, where the information is downloaded to a secure server, analyzed, interpreted by the monitoring service and reported back to the physician for the diagnosis.

As with event monitoring, if at any point an arrhythmia is identified, the physician is notified. However, a Holter monitor’s activity has already occurred and is being evaluated after the fact, while an event monitor’s activity is currently happening and can be addressed without delay.

2016 Nuclear Cardiology Benchmark Report Released

Posted on: 03.10.16

After a tremendous response to the Nuclear Cardiology Benchmark Report, Digirad has launched a new and updated version for 2016. The report gives users an unbiased evaluation of where their organization stands relative to national standards. The data used in the report was compiled by Medaxiom, as well as new provider information from 2015. Metrics covered within the report include the average number of new patient consults, study volume, number of cardiologists, camera age, and more.

The 2016 version of the report includes the ability for practices to create a customized report or download a standard version. Custom reports provide specific information on how your practice compares with industry benchmarks along with potential risk factors and quality improvement opportunities. The standard version of the report offers an easy and fast way to access the data without providing specific practice data.

Ready to view the information? Visit the Benchmark Report website today to download your standard or customized version.

Appropriate use criteria updates for 2016

Posted on: 03.03.16

Appropriate Use Criteria (AUC) is an evidence-based set of standards that are designed to assist professionals with decisions regarding appropriate treatment for patients with specific conditions. Included with the passage of the “Protecting Access to Medicare Act of 2014” (PAMA), was an appropriate use criteria program that includes advanced diagnostic imaging services (MRI, CT, and nuclear medicine).

Under the law, effective January 1, 2017, physicians who order these tests must consult with AUC, and physicians who perform these tests must provide documentation that confirms the ordering physician’s AUC adherence in order to be paid for the service.

AUC Timeline

The CY 2016 Medicare Physician Fee Schedule Final Rule identifies the components of the AUC plan as:

Establishment of AUC by November 15, 2015
Specification of clinical decision support mechanisms (CDS) for consultation with AUC by April 1, 2016
AUC consultation by ordering professionals and reporting on AUC consultation by furnishing professionals by January 1, 2017
Annual identification of outlier ordering professionals for services furnished after January 1, 2017.

Further clarification, and the process by which the CDS mechanisms will be specified, will be released by CMS after the CY 2017 final rule. Additional discussion and adopting policies regarding claims-based reporting requirements will also be included in both the CY 2017 and CY 2018 rules, which negatively impacts the likelihood that ordering and furnishing professionals will be expected to meet the program requirements by the January 1, 2017 deadline.

Establishing AUC

The establishment and finalization of AUC will be driven by local provider led-entities (PLE). The process by which a PLE is considered qualified by Medicare will be outlined in the final rule. These organizations will have the ability and the authority to develop, modify or endorse the criteria of other qualified PLEs, effectively lending itself to the creation of a larger, more clinically encompassing library.

Looking Ahead

Effective January 1, 2020, a prior authorization requirement for outlier professionals will be implemented. The final rule did not address this implementation, but CMS did propose to “identify outlier ordering professionals from within priority clinical areas that would be established through subsequent rulemaking.”

Considering the recommendation of the Medicare Evidence Development & Coverage Advisory Committee, The proposed list of priority clinical areas will be detailed in the CY 2017 PFS.

Learn more about Appropriate Use Criteria at the ASNC website and follow the Digirad blog for ongoing developments as they relate to imaging. Click here to read the full article.

How does mobile diagnostic imaging work?

Posted on: 03.01.16

Operating a nuclear diagnostic lab can be an expensive and time-consuming proposition. Many practices and cardiologists are turning to mobile diagnostic imaging as a way to improve profitability or add services to new locations.

A mobile imaging company can provide everything you need to offer nuclear imaging at your location – with no capital outlay or direct expense to your practice. These services include accreditation, licensing, personnel, equipment, consumables, and isotopes. Understanding how mobile diagnostic imaging programs work is the best way to know if the service can benefit your practice.

Why do practices use mobile imaging?

The first step in knowing how mobile imaging programs work is to understand the “why” behind the decision. Example situations where mobile diagnostic imaging makes sense include:

An existing practice may be interested in adding new imaging modalities and equipment so they can offer a full spectrum of cardiology services.
A new practice may want to offer in-office diagnostic imaging to patients, but are hesitant to make a large capital investment or realize that outsourcing is often more profitable than a full ownership approach.
A cardiology practice may be experiencing uneven volumes or expensive repairs on an older camera which is making the economics unfavorable.

Contracting with a mobile imaging partner

Prospective mobile imaging providers should review your clinical volumes to identify the overall need and then determine how many days of service would work best for your practice. It could be as little as a single day per month, up to several days a week. The number of service days and pricing terms should be based on your actual volumes to ensure you make a profit from providing the imaging.

What does a typical service day look like?

One day prior to your scheduled service day:

Your office will notify the provider with the scheduled appointments for the following day
The completed form will include the patient’s name, weight, and type of test ordered
This information is used to order the appropriate isotopes from the pharmacy

Service day:

The service provider arrives at your office at the designated time with all the personnel, equipment, and supplies
The camera is set up in an exam room and prepared to image patients
Imaging is performed throughout the day
Images are delivered to you based on your preferred method, most commonly via online PACS
At the end of the day, they pack up their equipment, supplies and leave the exam room as they found it

Wrap up:

Your practice will bill the insurance payers and collect payment
The mobile imaging provider can coach your staff through the coding process
Your practice pays the imaging provider for the service day

Mobile imaging can be an intelligent way to remove financial pressures while providing a better service to your patients. While this is a general idea of what to expect, the specifics of your practice and needs will shape the eventual process.

Preventative maintenance checklist for your nuclear camera

Posted on: 02.25.16

A preventative maintenance program is the most effective way to keep your nuclear camera operating at its best and address potential issues before they impact your practice. Most often, issues with SPECT and nuclear gamma cameras arise over time and a consistent, comprehensive program will ensure the optimal performance of your system. Additionally, a valid preventative maintenance program is required to satisfy accreditation and regulatory requirements, so it shouldn’t be taken lightly or, more importantly, sacrificed as a way to reduce costs.

What should be covered with preventative maintenance?

A preventative maintenance plan should include a detailed review, both visually and functionally, of the entire system. The following items are what should be checked at each visit:

Mechanical

Perform a visual review of the camera’s motion
Ensure that all appropriate parts are properly lubricated
Verify all limit switches, location sensors, and gears are in working order

Heat dissipation

Ensure fans are properly functioning, and filters are free of dust or debris
Listen for excessive noise, which may indicate the need for replacement
Look for excessive humidity levels

Image Quality Assurance

Verify that energy peaks are within the expected range
Confirm all uniformities are in good condition
For solid-state systems, ensure pixel maps follow manufacturer’s guidelines
Check x-ray alignment and attenuation correction, if applicable

Computer functionality

Review checks and balances on the computer to ensure optimum efficiency
Save all calibration backups to the server
Perform a final gauge check to ensure there are no other issues

How often should maintenance be performed?

Generally, stationary systems should receive preventative maintenance twice per year, and mobile imaging systems should have a maintenance check at least three times a year. While most practices would benefit most from a contractual preventative maintenance program, many providers also provide on-demand service.

Preventative maintenance programs allow for quicker identification and resolution of camera issues and ensure your system is working at an optimum level at all times. When compared to on-demand service, a preventative maintenance program is less expensive in the long run and can provide you with 24-hour service, technical support, software updates, priority parts, expedited delivery and discounts on labor costs, to name a few.

Are you considering a preventative maintenance program for your camera? We would love to help! Learn more about Digirad’s preventative maintenance programs here.

What is a Stress Test?

Posted on: 02.18.16

Myocardial Perfusion Imaging, also called Nuclear Stress Testing, is used to assess coronary artery disease, or CAD. CAD is the narrowing of arteries to the heart by the buildup of fatty materials. This condition may prevent the heart muscle from receiving adequate blood supply during stress or periods of exercise. It frequently results in chest pain, which is called angina pectoris.

A stress test provides detailed information about how efficiently your heart performs during physical stress. The test consists of injecting a small dose of radioactive material into the patient’s bloodstream, via an IV, and then imaging the heart commonly under two scenarios: the resting phase and the stress phase. Aptly named, the rest phase is the time at which the heart is at rest, prior to any exercise. The stress phase is the period of time after exercise when the heart is working hard and beating fast.

A stress test typically involves pedaling a stationary bike or walking on a treadmill at increasing levels of difficulty while your blood pressure and heart rate are being monitored. Images of your heart are taken with a nuclear camera prior to, and after, exercise. The comparison of the images can help identify any abnormalities and support a diagnosis.

Why do a stress test?

There are many reasons that your physician might order a stress test:

To monitor the blood flow to your heart during increasing levels of activity
To evaluate the effectiveness of any prescribed heart medication
To determine the likelihood of having coronary heart disease
To assess the effectiveness of a prior heart procedure
To identify an abnormal heart rhythm
To measure the reduced function of heart valves

A nuclear stress test is safe and highly effective in detecting irregularities. When the test is complete, patients may return to normal activities unless otherwise instructed. If the stress test identifies an issue or a concern, the doctor and patient will discuss an appropriate treatment plan.

Understanding Attenuation Correction

Posted on: 02.11.16

Ultimately, the goal is to reduce the impact of attenuation in order to provide images that are more uniform and allow for higher reading confidence.

During SPECT Myocardial Perfusion Imaging, radiation is absorbed by the heart and therefore, the heart becomes the source of gamma rays detected by the camera. The detectors read the rays to produce an image. The size of the patient and the amount of tissue between the heart and the detector lead to attenuation artifacts that adversely affect the image of the heart. The attenuation correction process uses a second form of imaging to develop a density map of each individual patient and corrects the SPECT image accordingly.

Attenuation correction methodologies

There are several methodologies of attenuation correction associated with Myocardial Perfusion Imaging. The primary methods include Gadolinium line source, SPECT/CT, and fluorescence X-ray. Fluorescence X-ray offers attenuation correction with much less radiation exposure to patients compared to SPECT/CT, and a higher quality density map than line source.

By utilizing fluorescence, Digirad’s X-ACT camera can perform attenuation correction with a radiation dose of less than five microsieverts. The X-ACT does not require any shielding, the replacement of any line sources, or any room modifications required for SPECT/CT imaging.

With increased sensitivity in the public and medical community concerning radiation, the fluorescence method contributes to the continued effort of keeping each patient’s lifetime radiation burden at its lowest possible level.

February Healthcare News Update

Posted on: 02.04.16

The Role of Vascular Medicine in Cardiology

Speaking from the American Heart Association (AHA) 2015 Scientific Sessions, Samuel Z. Goldhaber, MD, talks about where vascular medicine fits into cardiovascular medicine. In the opening address at the Sessions in Orlando, Dr. Mark Creager, cardiologist, vascular medicine specialist and President of the American Heart Association, called for much more attention to vascular medicine within the realm of cardiology, so this topic is on point. Continue reading…

CVD Risk Increased With Early- vs Late-Onset Diabetes

Under lead author Xiaoxu Huo, PhD, Tianjin Medical University, China, investigators used China’s largest diabetes database to compare the risk of developing nonfatal CVD in early- vs late-onset type 2 diabetes among residents of mainland China. The study indicated that the risk is almost twice as high in patients who develop type 2 diabetes before the age of 40 compared with those who develop later-onset disease, although the risk is attenuated when adjusted for disease duration. Continue reading…

New Clues Why Women Get Broken Heart Syndrome

Harmony Reynolds, a cardiologist at NYU Langone Medical Center, recently led a study that subjected 20 women to a host of tests designed to bring on physical and mental stress. The study looked for possible reasons why some of the women suffered a mysterious ailment known as broken-heart syndrome, which mimics a heart attack but generally doesn’t appear to be due to coronary artery disease. Continue reading…

Medicare is Changing: What’s New for Beneficiaries

Whether it’s coverage for end-of-life counseling or an experimental payment scheme for common surgeries, Medicare in 2016 is undergoing some of the biggest changes in its 50 years. Today, the nation’s flagship health-care program is seeking better ways to balance cost, quality and access. The effort could redefine the doctor-patient relationship, or it could end up a muddle of well-intentioned but unworkable government regulations. Continue reading…

Farewell message from outgoing President, David Wolinsky, MD

I am proud to say that ASNC has had an extraordinarily successful year. We have advanced the major pillars that have been the foundation of ASNC – quality, education and advocacy. New guidelines have been developed on Stressors and Tracers. Existing guidelines have reached a far broader audience with translation into Spanish. The ASNC ImageGuide Registry™, is up and running and is expected to generate its first set of quality improvement data early in 2016. Continue reading…

What is an event monitor?

Posted on: 01.21.16

An event monitor, also called an ambulatory electrocardiographic monitor, is a battery powered, portable medical device that monitors cardiac activity as a patient goes about an ordinary day. The main purpose of an event monitor is to determine the cause of a transient event by recording a patient’s heart rate and rhythm during a period of time.

In contrast to an EKG, which captures cardiac activity at one point in time, or a Holter monitor, which continuously records over a period of 24-48 hours, an event monitor records intermittently for a period of a few weeks, typically up to 30 days. It is typically prescribed because a prior method of monitoring failed to obtain necessary data, likely because the patient’s symptoms are unpredictable or infrequent, generally occurring less than daily. An event monitor allows for longer monitoring time and a greater chance of capturing an irregularity.

Types of event monitors

Event monitors typically include wired sensors that are attached to the patient’s chest which are then connected to a small recording device. There are two types of event monitors:

A looping memory monitor, the most common type of event monitor, can be programmed to record ECG activity for a given period of time. When the patient experiences symptoms, he pushes a button to activate the device, which triggers the monitor to record the 60 seconds prior to the event, the event, and up to 40 seconds following.

A post-event monitor is typically a handheld device or one that can be worn on the patient’s wrist, similar to a bracelet. The small metal discs that are located on the back of the device function as electrodes When the patient experiences symptoms, the monitor is placed on the chest and the patient activates the recording button. This records the current ECG activity. Unlike the looping memory monitor, however, a symptom event monitor will not store any ECG activity that occurs in the minutes prior to its activation.

Both devices are able to send the ECG by telephone to a receiving center or a doctor’s office for review. Any emergency treatment, further testing or monitoring will be addressed as needed.

Who is Reading Your Cardiac Data?

Posted on: 01.14.16

There are many variables to consider when selecting a cardiac monitoring service. Each provider has their own mix of technology, process, and service. While the type of technology used to capture patient data is critical, it’s even more important to know who is reading the data.

Readers can range from an automated computer system to a seasoned RN with years of critical care experience. Each category of readers provides a graduated level of service- from the bare minimum to the most advanced. It’s important to understand what level of reading technician each provider employs and, in turn, how that will impact the burden you and your staff absorb. Three high-level categories of monitoring include:

Computer Monitored

This basic level of monitoring is managed by the reliance on algorithms. It is an automated system that alerts the monitoring company of any abnormality based on specific criteria. Generally, a raw, unedited report is sent to the physician for evaluation and interpretation. With this method, the physician’s office retains the responsibility in terms of analyzing the data in a timely manner.

Technician Monitored

Many monitoring services are staffed with Certified Rhythm Analysis Technicians (CRATs) and/or Certified Cardiac Technicians (CCTs). These technicians have experience with administering EKGs, and reading and troubleshooting reports. Comparable levels of technicians include those who may have attended a monitored technician course in order to learn how to interpret EKGs or those who may have been hired by the monitoring service and are provided with on-the-job training.

Registered Nurse Monitored

The highest level of cardiac monitoring reading expertise includes a combined staff of registered cardiac nurses and technicians. Registered nurses are college educated, state board certified and, in many cases, certified in additional specific areas of expertise.

Registered nurses generally bring with them years of valuable critical care experience. Their ability to leverage that experience while watching and analyzing EKG results and evaluating their patients’ signs and symptoms adds significant value to the overall monitoring service. Their expertise allows them to serve as an extension of the physician as they ask critical questions and provide comprehensive care and comfort by way of a more holistic approach.

Making the Choice

Cardiac monitoring providers offer distinctly different levels of service when it comes to who reads the data. When evaluating these providers, determining who is caring for the patient is a critical component in the decision-making process. Any monitoring partner you utilize is an extension of your patient care, so it’s important to choose one that not only meets your outsourcing needs, but also your standards and level of patient care.

January Healthcare News Update

Posted on: 01.07.16

SNMMI 2016 call for abstracts

The Society of Nuclear Medicine & Molecular Imaging (SNMMI) is now accepting abstracts for the SNMMI 2016 Annual Meeting, June 11-15, 2016 in San Diego, California. The Scientific Program Committee welcomes physicians, scientists, technologists, lab professionals, and educators/course directors with the opportunity to present and publish innovative scientific investigations to medical imaging professionals from around the world. Continue Reading…

ACC, SCAI and HRS commit to cardiovascular public reporting program

Major cardiovascular societies are increasing their public reporting of data to help patients obtain information on hospitals’ care delivery and improve the quality and cost of care, according to an advisory published online in the Journal of the American College of Cardiology. “The most compelling justification for public reporting is the right of an individual to know about the care that he or she is likely to receive,” the societies wrote. Continue Reading…

Rate of adults with high total cholesterol declines in U.S.

The proportion of U.S. adults with high total cholesterol and low high-density lipoprotein (HDL) cholesterol has decreased in recent years, according to data released by the Centers for Disease Control and Prevention. Continue Reading…

Top 6 trending payment models demanding new long-term focus

Paying for outcomes gained instead of mere services rendered is the new name of the healthcare game. This means the simple notion of paying for multiple physician visits, medical procedures, and the like is no longer tied to volume but value. Although counterintuitive, the focus on quality over quantity may actually bring in more revenue compared to a more traditional payment model approach. Continue Reading…

Predicted heart age is older than chronological age in most U.S. adults

Most adults in the U.S. have a predicted heart age that is significantly higher than their chronological age, according to the Centers for Disease Control and Prevention (CDC) study recently released. The average predicted heart age was 7.8 years older than chronological age for men and 5.4 years older than the chronological age for women. Continue Reading…

Predicting 30-day readmissions for heart failure patients remains challenging

A model developed to predict 30-day readmissions for heart failure found that having patients self-report their socioeconomic, health status and psychosocial characteristics did not improve the researchers’ ability to determine the readmissions risk. Harlan M. Krumholz, MD, SM, of the Yale School of Medicine in New Haven, Conn., and colleagues published their results online in the Journal of the American College of Cardiology: Heart Failure. Continue Reading…

Digirad Corporation Announces Closing of DMS Health Technologies Acquisition and Associated Financing From Wells Fargo

Posted on: 01.05.16

SUWANEE, GA and FARGO, ND, Jan. 05, 2016 (GLOBE NEWSWIRE) — Digirad Corporation (NASDAQ:DRAD) (“Digirad” or the “Company”), the leader in providing healthcare solutions on an as needed, when needed, and where needed basis, announced today that it has closed the acquisition of DMS Health Technologies, Inc. (“DMS Health”) as of January 1, 2016.

As previously announced the Company expects the new combined Digirad entity to generate pro forma annual revenue and adjusted EBITDA of over $125 million and $17 million, respectively.

The Company also announced closing on a senior secured credit facility from Wells Fargo Bank, with a total commitment for up to $40 million that the Company used to partially fund the transaction along with cash on hand. At a fully funded level, the current weighted average interest rate of the senior facility is approximately 3.24%.

Headquartered in Fargo, North Dakota, DMS Health has approximately 250 employees. DMS Health’s diverse portfolio of medical equipment and diagnostic imaging services provide healthcare systems with access to the technology necessary to provide exceptional patient care in today’s rapidly changing healthcare environment throughout the United States.

In connection with the acquisition and as a material inducement to entering into employment with Digirad, on January 1, 2016 (the “Grant Date”), Digirad granted 20,000 restricted stock units to R. William Vogel, and 10,000 restricted stock units to each of two other newly hired employees as inducement awards under NASDAQ Listing Rule 5635(c)(4) (the “Inducement Awards”). Mr. Vogel will serve as the Chief Executive Officer of DMS Health Technologies, Inc. The Inducement Awards will vest, subject to the recipient’s continued service, in equal annual installments over three years following the Grant Date. The Inducement Awards were approved by the Compensation Committee of the Board of Directors of Digirad and granted under the Digirad’s 2011 Inducement Stock Incentive Plan (the “Plan”). The Inducement Awards were granted in reliance upon the exception provided under NASDAQ Listing Rule 5635(c)(4) and are subject to the terms of the Plan and the award agreements entered into with each recipient.

December Healthcare News Update

Posted on: 12.31.15

Remote Diagnostic Monitoring Progress: Medicare Payment Increase, GAO Study, Legislation Pending

The 2016 Medicare physician payment fee schedule includes a significant increase in payment for a critical diagnostic test used to diagnose cardiac arrhythmias and other heart rhythm disorders – mobile outpatient cardiac telemetry. The payment increase reflects Medicare’s recognition of some of the unique costs associated with providing remote diagnostic monitoring services including wireless transmission of clinical data. Continue Reading…

CMS pushes back deadline for imaging decision support

The U.S. Centers for Medicare and Medicaid Services (CMS) has postponed its January 1, 2017, deadline for physicians to start ordering advanced imaging studies with clinical decision-support software that is based on appropriate use criteria. The deadline is currently on hold, according to the Medicare Physician Fee Schedule final rule released last month. The mandate, established last year, will require outpatient clinicians to use CDS tools to consult appropriate use criteria when ordering MRI, CT and nuclear imaging exams. Continue Reading…

Transitional Care Interventions Cut Risk of Readmission in CHF

For patients with congestive heart failure, transitional care interventions (TCIs), especially high-intensity TCIs, are effective for reducing the risks of readmission and emergency department visits, according to a review published in the November/December issue of the Annals of Family Medicine. Continue Reading…

SPRINT trial finds lowering systolic blood pressure target improves outcomes

For adults who were at least 50, with an increased risk of cardiovascular events and who did not have diabetes, reducing the systolic blood pressure target to less than 120 mm Hg led to lower rates of fatal and nonfatal major cardiovascular events and death from any cause compared with the standard target of less than 140 mm Hg. These findings, from the SPRINT (Systolic Blood Pressure Intervention Trial) study, were presented on November 9 at the American Heart Association (AHA) Scientific Sessions and simultaneously published online in the New England Journal of Medicine. Continue Reading…

Save the Date: Nuclear Cardiology Today

The American Society of Nuclear Cardiology will host Nuclear Cardiology Today: A Comprehensive Review and Update on April 29-May 1, 2016, at the Chicago Marriott O’Hare. Continue Reading…

HOPPS and MPFS Charts Released

Posted on: 12.17.15

In an effort to control the rapidly growing Medicare expenditures for outpatient services and the large co-payments being made by Medicare beneficiaries, the Centers for Medicare and Medicaid Services (CMS) created the Hospital Outpatient Prospective Payment System (HOPPS). This payment system provides a fixed, prospectively determined, bundled payment for hospital-provided outpatient products and services, excluding services of physicians and other health care providers.

For the same reason, CMS developed the Medicare Physician Fee Schedule (MPFS) to reimburse physician services. The MPFS is funded by Part B and is composed of costs associated with physician work, practice expense and professional liability insurance.

On October 30, 2015, CMS released the Medicare Physician Fee Schedule Final Rule for CY2016 and the Hospital Outpatient Prospective Payment Systems. Overall, there is no change in the estimated combined impact on total allowed charges for cardiology from 2015 to 2016. However, you should note that CMS finalized its proposal in the HOPPS rule to restructure the nuclear medicine APCs and added an additional APC (5594: Nuclear Medicine and Related Services) which will be composed of PET imaging.

For further details see the charts below:

CY2016 Medicare Physician Fee Schedule Payment Chart

CY2016 Hospital Outpatient Prospective Payment System Chart

Four Critical Components of an Effective Risk Assessment

Posted on: 12.10.15

Security risk assessments play a vital role in making sure your patient data is safe and secure. Many organizations believe that a simple vulnerability scan will satisfy the requirement for a risk assessment, but the fact is that it’s only one element. A complete and compliant risk assessment must include four distinct components. These include:

1. Technical Safeguards

Technical safeguards are those that protect the aspects of how you’re storing your personal health information and are generally tested by running a vulnerability scan. The vulnerability scan is an automated test that identifies network security weaknesses.

2. Organizational safeguards

Organizational safeguards primarily address the “minimum necessity rule.” This Rule is designed to ensure and determine who has access to specific data and to consider whether it is required or necessary to perform their duties. If any person has more access than they need, you’ve created an organizational vulnerability.

3. Physical safeguards

Physical safeguards speak to the physical protection of information. You are the custodian of privileged patient information and are responsible for it’s care. This component includes precautions that defend against physical and environmental hacking, such as building security, key card access, off-site data replication and recovery and firewall protection, just to name a few.

4. Administrative safeguards

Administrative safeguards are the protection of information from a legal perspective and include such things as business associate agreements, employee confidentiality agreements, background checks, termination checklists and the implementation of formal policies and procedures. It’s critical to be able to administratively ensure that you have proper documentation and processes in place to terminate an employee’s access and maintain compliance, especially in an environment where technology plays such a large part.

What to do after a security risk assessment

It’s important to remember that performing a security risk assessment is only the first step in a process. Once all of the vulnerabilities and deficiencies are identified, the next step is to design and implement a remediation action plan. The key to compliance is continually repeating the process and addressing the issues. Technology and business change on a daily basis so it’s critical for your compliancy program to remain fluid.

Featured Expert: This post was written with the assistance of Jim Johnson, President of Live Compliance. Live Compliance specializes in HIPAA regulation compliance and training and is the provider of Digirad’s Compliance Program.

What MACRA means for your practice

Posted on: 12.03.15

On April 16, 2015, President Obama signed the “Medicare Access and CHIP Reauthorization Act of 2015” (MACRA) into law. With that passage, the flawed Sustainable Growth Rate (SGR) program has been eliminated, a victory to be celebrated by the medical community. Aside from that win, the act also includes other important legislation that will substantially affect the healthcare industry.

Assuming risk

One of the most significant changes is the proposed amount of risk physicians and hospitals will need to take in dealing with traditional Medicare. In 2016, 30% of healthcare will be required to be delivered by alternative payment models, rising to 50% in 2018. Although not yet defined, it’s clear that when MACRA takes effect, providers will be required to assume an even greater amount of risk. That forecast leads us to the critical question of how to deliver efficient healthcare that is both high quality and low cost.

Population health

Physicians and hospitals will need to approach this population health issue from a different perspective than before. With a responsibility to patients’ health and a fixed amount of funds, they’ll need to look at how to deliver healthcare within the confines of providing high-quality service at a lower cost. We expect to see more involvement in preventative medicine and providers who place more attention on determining the most efficient and cost-effective methods for patient care. This will impact many areas throughout healthcare, especially cardiovascular care.

Public information

Today, individuals are directly purchasing their healthcare and consumers are increasingly more aware of their out of pocket costs. With the amount of public information available, including individual physician and hospital comparisons, it’s incredibly important for providers to strike a balance in terms of cost and quality. Being competitive is not only a benefit for patients but also from a business perspective. Insurance companies must evaluate and choose the top tier of providers who offer the best combination of cost and quality. Those that don’t make the cut could stand to lose current patients as well as access to future patients.

Safeguarding Health Information Conference Recap

Posted on: 11.19.15

On September 2-3, 2015, the National Institute of Standards and Technology (NIST) and the Department of Health and Human Services Office for Civil Rights (OCR) co-hosted the 8th annual conference, Safeguarding Health Information: Building Assurance through HIPAA Security, at the Grand Hyatt in Washington, D.C.

The conference explored the current health information technology security landscape and the Health Insurance Portability and Accountability Act (HIPAA) Security Rule. It highlighted the present state of health information security, and practical strategies, tips and techniques for implementing the HIPAA Security Rule.

Live Compliance president, Jim Johnson, was among the conference attendees and stressed the importance for all organizations, regardless of size, to stand up and take action. In reviewing the conference, Johnson identified three key takeaways from the sessions including:

It’s only the beginning

Iliana Peters, J.D., LL.M, Senior Advisor for HIPAA Compliance and Enforcement at the HHS Office for Civil Rights acknowledged that HIPAA is in its infancy, but also stated that this initiative is only the beginning for rule making. The more instances of non-compliance discovered by the OCR, the greater number of fines and penalties that will be levied against organizations that do not want to play by the rules.

Not just for large organizations

The penalties we hear most about are the expensive and exciting newsworthy ones that are charged against large organizations. The simple translation by smaller organizations is that the OCR won’t bother auditing a practice of their humble size when they have bigger battles to fight and larger penalties to collect. Contrary to that belief, the OCR will be assessing more $5,000 and $10,000 fines, emphasizing and demonstrating that these rules apply to every person and organization that handles PHI. A single-physician practice has as much obligation to comply as does a 40-doctor surgery center.

The importance of risk assessments

With the continuous development of regulations addressing patient privacy and the far-reaching consequences for non-compliance, an annual risk assessment is critical. Many organizations run a vulnerability scan and believe they have satisfied their assessment responsibility. In actuality, they’ve only completed one component of an effective risk assessment. During an assessment, organizations need to consider where their PHI is located and who has been given access to it. Continually evaluating who requires access to the data should be the driving factor in an effective evaluation.

In summarizing the event, Johnson stated “HIPAA regulations apply to all organizations that work with protected or personally identifiable patient information, not just large organizations. Forty-doctor offices and under need to take notice that the Office for Civil Rights is standing strong behind these rules and will ensure that everyone is in compliance.”

Dilon Diagnostics and Digirad at RSNA

Posted on: 11.12.15

Dilon Diagnostics is a leader in small field-of-view cameras for early detection of breast cancer. From a diagnostic perspective, 50% of women who have a mammogram in the U.S. are found to have dense breast tissue and therefore, have an inconclusive mammogram. Many times, in order to rule out breast cancer, a secondary diagnostic procedure is required. These procedures can include an ultrasound, MRI, or in the case of Dilon Diagnostics, molecular breast imaging.

With their Molecular Imaging System considered leading edge technology, and a strong weapon in the armament against breast cancer, the company quickly grew internationally as well as domestically. It’s estimated that worldwide, close to 1 million women have had a molecular breast imaging procedure performed.

A thriving partnership

Dilon has had a long-standing relationship with Digirad, as both a business partner and a supplier. Leveraging those initial relationships, they entered into an agreement whereas Dilon would be the exclusive international distributor for most of the countries worldwide for Digirad’s lines of molecular imaging cameras including the Ergo™, the Cardius® X-ACT, and the Cardius® XPO series of dedicated cardiac SPECT imaging systems.

Radiology Society of North America

For this year’s Radiology Society of North America (RSNA) show, which will be held November 29 through December 4, 2015 at McCormick Place in Chicago, IL, Dilon invited Digirad to share their booth as co-exhibitors. Digirad will be showcasing the Cardius® X-ACT at the exhibit this year.

Dilon will highlight their newest system, the Acella Gamma Camera, which features a much larger MBI detector (made by Digirad), making Dilon the first company in the industry to offer customers a choice in detector sizes.

In addition to the Digirad and Dilon products, Dilon will also be featuring some complimentary products; SurgicEye’s declines®SPECT, used for mobile 3D SPECT imaging, and AG Medical’s CoTi, which measures the amount of radiation dosage that a person receives when treated for thyroid cancer.

Be sure to visit Dilon and Digirad at Booth #7927. We’d love to share more information about these products and introduce you to the future in technology!

Perma-Fix advances Tc-99m production technology

Posted on: 11.05.15

The following article originally appeared on AuntMinnie.com. Click here to read the full article.

Concern over the future supply of medical isotopes in the wake of recent worldwide shortages and aging nuclear reactors has spawned a kind of cottage industry among entrepreneurs. One such firm is Perma-Fix Medical, which is developing a method for producing technetium-99m (Tc-99m) that does not require uranium.

The company’s neutron-capture production process is designed to activate natural molybdenum (Mo) to produce Mo-99, which then decays into Tc-99m. By removing uranium from the production chain, the new process can be performed locally using standard research and commercial nuclear reactors, rather than one of the five research reactors in the world currently capable of processing enriched uranium.

At the heart of the technology is the company’s specialized resin, which is radiation resistant, holds large quantities of molybdenum, and releases almost 90% of the Tc-99m as it forms from the decayed Mo-99.

“It is a simple solution to a complex issue,” said Stephen Belcher, Perma-Fix Medical’s CEO. “It is taking a normal generator, replacing the aluminum core with this resin core, and then applying the radioactivity to this core. We can radiate it, have activated molybdenum, and apply it to our resin core.”

Continue to AuntMinne.com for the full article

Is it time to move to an EHR system?

Posted on: 10.29.15

Transitioning from paper-based health records to an Electronic Health Records (EHR) system is a move that will affect almost every aspect of your practice. There are many benefits to an EHR system, but these benefits come with a cost. You’ll need to invest in the software and train your staff in new processes. So why are practices making the move to EHRs? We’ve put together six key benefits of making the switch. Take a look…

Fewer errors

Digital data allows for fewer errors than traditional paper records. Among other things, legibility is no longer an issue and physicians can be prompted to include information that they may otherwise forget to communicate.

Safety

Patient safety is one of the most important concerns in providing care. From the safety of records management, including patient privacy and security, to the reduced duplication and electronic delivery of prescriptions to the pharmacy, EHRs substantially increase safety through a variety of different mechanisms and safeguards.

Cloud Based Options

Newer, cloud-based EHRs can be securely accessed from any computer with an internet connection, whether that’s from an exam room, your home office, the emergency room or even from your favorite vacation spot. It allows physicians immediate access to an organized and complete history of care instead of the limited notes from the patient’s last office visit.

Time savings

More important than the obvious time saved by not having to manually chart a patient’s visit to the office is the time saved during a crisis. During an emergency, the value of having accurate and comprehensive health information at your fingertips is priceless. Access to blood type, documentation of any known allergies, and other crucial details can help physicians make quicker and more confident decisions in critical patient care.

Easier collaboration

Test results, diagnostic reports, prescribed medications, notes, questions, and recommendations for a single patient are all in one place. Whether across the country or across the street, two providers or ten, electronic records facilitate more effective collaboration and communication among physicians, especially when addressing multiple facets of the patient’s care.

Administrative efficiencies

Imagine not having to store hundreds or thousands of paper records. EHRs provide instant storage and retrieval of records. Your office staff will substantially increase efficiency by spending less time managing paperwork and more time on other tasks.

EHRs are soon to be the standard in medical records, not necessarily because of the conveniences and efficiencies, but more so because the technology substantially improves the safety, quality, and delivery of patient care. Migration to electronic records is not only innovative and forward thinking, it’s almost a necessity in today’s medical environments.

MedAxiom Fall 2015 CV Transformation Conference – Event Preview

Posted on: 10.22.15

MedAxiom’s highly anticipated Fall ’15 CV Transformation Conference will be held in Dallas, Texas from October 23-25, 2015. Attendees will gather with industry leaders to to discuss industry trends, practical business applications and best practices.

Featuring presentations from the nation’s top thought leaders, including keynote speaker Dr. Michael S. Cuffe, President and CEO of the Physician Services Group for Tennessee-based Hospital Corporation of America (HCA), organizations will learn how to stay ahead of the curve in today’s rapidly changing and complex health care environment. From timely general session topics to detailed breakout presentations and more intimate POD group discussions, attendees will have a variety of opportunities to gain in-depth insight and real-world solutions for the challenges we face as an industry.

Digirad recently spoke with Patrick White, President of MedAxiom, who shared his excitement about the conference, the topics to be discussed, and the programs to be launched. He highlighted the pre-conference arena where they’ll be kicking off a 4-part Physician Leadership Series led by Dr. Ed Walker, founding director of the University of Washington Healthcare Leadership Development Alliance.

During the conference, cardiovascular service line management agreements will be a hot topic as will be the idea of population health, and MACRA (Medicare Access and CHIP Reauthorization Act). White takes pride in the fact that many of the presentations and case studies are given by MedAxiom members. “The benefit to the attending member is that they can listen to one of their peers speak about a specific problem they encountered, the intervention and the results. We bring people together which helps them learn from each other very quickly. That really accelerates the learning curve,” White said.

Digirad will be an exhibitor at the conference. Visit us in the exhibit hall and we look forward to seeing you in Dallas.

Imaging Industry News – October

Posted on: 10.15.15

The imaging industry is ever-changing, so it’s important to stay up to date on advancements and issues that may impact the development, operation, maintenance, and growth of your imaging services. Here are some important developments:

Call to Action: Nuclear Medicine Reimbursement

The Centers for Medicare and Medicaid Services (CMS) has proposed changes to the nuclear medicine Ambulatory Payment Classifications (APCs) in its 2016 proposed rule for the Hospital Outpatient Prospective Payment System (HOPPS). Concerned that the proposed rule will exacerbate an already existing nuclear medicine reimbursement problem, The Society of Nuclear Medicine and Molecular Imaging (SNMMI) created an APC Remodeling Task Force, which has spent the last 1½ years collecting and analyzing data and developing a proposal in collaboration with other nuclear medicine stakeholders. Read more..

WomenHeart launches first virtual support network for women living with atrial fibrillation and their caregivers

The National Coalition for Women with Heart Disease has launched the first virtual support network specifically for women living with atrial fibrillation. The WomenHeart Virtual Support Network is part of WomenHeart’s national patient and public education campaign about atrial fibrillation and stroke risk and is designed to provide critical education and emotional support to women living with the heart condition. Read more…

Heart Age Tops Actual Age in the United States, CDC Says

A new and simpler way to express a person’s risk for a heart attack or stroke still shows the nation to be heart unhealthy on average, but a person’s heart age metric may provide more motivation for patients to adopt healthier lifestyles, the Centers for Disease Control and Prevention (CDC) said today. Heart age is defined as the predicted age of a person’s vascular system based on their cardiovascular risk factor profile. Read more…

Risk of Death Increased by 50% in Smokers With Diabetes

Being a smoker and having diabetes increases the relative risk of total mortality and cardiovascular events by about 50%, and quitting smoking can reduce these risks, according to a new study published online in Circulation. “Smoking should be routinely evaluated and closely monitored for diabetic patients. As shown in our study, active smoking is associated with increased risks of total mortality and various cardiovascular events among diabetic patients,” commented first author An Pan, Ph.D. Read more…

Challenges and obstacles of the PQRS

Posted on: 10.08.15

The Physician Quality Reporting System (PQRS) is a quality monitoring reporting program that was launched by the Centers for Medicare & Medicaid Services (CMS) to improve care through accountability and disclosure. Under PQRS, healthcare providers report quality measures about the services they have provided to Medicare beneficiaries.

These quality measures help assess care in terms of patient outcomes, perceptions, and organizational structure. They ultimately contribute to achieving a higher standard of care by focusing on effective, safe, patient-centered, equitable and timely delivery of treatment.

Challenges and Obstacles

Non-compliance with the PQRS program will result in fees and penalties. Eligible professionals that do not satisfactorily report data on quality measures in 2015 will be subject to a 2.0% adjustment in their fee schedule. Penalties for the 2015 reporting period are set to be assessed in 2017.

Although the PQRS rules directly impact the profitability of every practice, many have still not implemented this protocol. Why? Providers are not adequately educated about the program, overwhelmed by the perceived effort required to implement the program, or simply unaware it exists.

Benefits

Aside from the financial impact of participating in the reporting program, there are other substantial advantages that benefit both providers and patients. With the results of this reporting, physicians can more easily:

Assess the quality and enhance the care they provide to their patients
Work with their patients to make informed decisions together, which lead to improved quality of care, improved health outcomes, and an increase in their overall quality of life
View their published quality metrics alongside those of their peers so that they can quantify and track the quality of their services

For more information on PQRS and step-by-step instructions for getting started, visit the Centers for Medicare & Medicaid Services here.

Five ways a Cloud PACS can help your practice

Posted on: 10.01.15

With advancements in technology, a traditional PACS (Picture Archiving and Communication System) is no longer your only choice when it comes to image storage and retrieval. A cloud-based PACS removes many of the limitations of a traditional PACS. Cloud based PACS offer benefits and conveniences that increase efficiency, accessibility, and ultimately, the level of patient care. Some of these advancements include:

Storage

Storage in a cloud-based PACS is typically off-site and virtual. There’s no need for onsite servers, hard drives or the physical installation of software. Patient data is automatically streamed directly into the cloud as it’s created. The storage is easily scalable, allowing the cloud to grow as your organization grows.

Access

Gone are the days of having to be tied to the office to view studies. With a cloud-based PACS, physicians, technicians, and administrators are able to access patient files by logging into a secure PACS application anywhere there’s an internet connection. Easily sharing data, forwarding referrals and the ability for multiple people to access data simultaneously are standard functionality.

Data Recovery

Virtualization provides an automatic disaster recovery plan. The servers, software, network configuration and security are automatically replicated and stored in a separate offsite disaster recovery cloud. In the event of a disaster, the cloud recovery will provide the quickest and most efficient data recovery and restoration.

Cost

Cloud-based storage can save a considerable amount of money on both capital and operating expenditures. This technology allows for the consolidation of multi-vendor storage resources, which substantially reduces storage costs. There is also a significant reduction in maintenance and repair since the vendor is responsible for maintaining all offsite equipment and software. Many vendors offer a variety of payment options, including pay-as-you-go, monthly plans, payments per study, and one-time fees. You can structure your payments in the way that is best suited for your office.

Security

The security of the system and all the data transmitted via the web is encrypted and protected appropriately, even if you are using a shared network. You’ll no longer have to be concerned about the safety of your patients’ information.

A cloud-based PACS not only offers conveniences, it also offers the latest advancements in technology. Improved collaboration, image sharing in real time, anywhere access…these benefits positively impact the operation of your organization, while reducing costs and operational responsibilities. In the big picture, it ultimately allows you to devote more time providing your patients with the best, comprehensive medical care available.

ICD-10 Set to Launch on October 1, 2015

Posted on: 09.24.15

After multiple delays, it’s finally official. The 10^th edition of the International Classification of Diseases (ICD-10) will be implemented on October 1, 2015. More than 68,000 codes will be available for the billing and coding of medical services and diagnoses.

While the update is a positive step in modernizing our health care infrastructure, it also brings a level of concern over the anticipated learning curve and the frustration that comes with it. Given the years of delays in the implementation schedule, the hope is that practices have used that time to prepare and plan for the costs they will incur as a result of the change.

Are you prepared for the switch?

October 1 is quickly approaching. Hopefully your staff has an understanding of what changes ICD-10 will bring and you’re ready for the transition. If that’s not the case, time is of the essence. Check out this list of provider resources, which includes a Quick Start Guide and the Road to 10 website, both offered by the Centers for Medicare and Medicaid Services (CMS).

ICD-10 will impact every aspect of how your practice operates so it’s not only important to be prepared, it’s critical. The conversion, although a disruption that most would choose to avoid, will include substantial benefits that are far reaching and, looking back, will have been well worth the effort.

Want to learn more? Read some of our previous blog posts that focus on the ICD-10 transition:
What is ICD-10?
ICD-10 Update: What you need to know

ASNC 2015 is underway!

Posted on: 09.17.15

The 20th Annual Scientific Session of the American Society of Nuclear Cardiology (ASNC) is underway through September 20th at the Washington Marriott Wardman Park Hotel in Washington, D.C.

Digirad is exhibiting and our team is ready for three days of learning and connecting with attendees. Stop by Booth 401 to say hello and learn about our new cost efficient diagnostic services program – Digirad Select.

We’ll also be exhibiting the Cardius® X-ACT and demonstrating our ground breaking technology that helps physicians meet all of the current ASNC guidelines including low dose imaging.

For more information, visit the ASNC website. See you at the show!

Brain Death Studies with Portable Imaging

Posted on: 09.10.15

Performing a Tc-99m Brain Death, or Intracerebral Perfusion, scan presents a unique set of challenges. Moving an unstable patient to the imaging department can be difficult for hospital staff and potentially hazardous to the patient. It is also an extremely sensitive and traumatic experience for the patient’s family.

Brain Death Study Considerations

Patients requiring a brain death study typically are on life support which makes the study logistically complex. Traditionally, brain death studies are performed in the imaging department with the use of a stationary camera. The patient must be carefully stabilized then transported with all the equipment, including power, which necessitates multiple hospital staff members to oversee and handle the transfer. The staff members often need to monitor the patient in the imaging department for the entire duration of the study. This can be costly, as well as challenging for critical care teams left on the patient floors to operate at reduced capacities.

Improving Brain Death Studies with Portable Imaging

The ideal way to handle brain death studies is with the use of a portable imaging system. In doing so, the technologist and the camera are delivered to the patient’s bedside to perform the study, essentially bringing the imaging department to the patient.

Using a portable camera causes substantially less disruption and creates a more peaceful experience while dealing with a traumatic event. Portable systems, such as the Ergo, offer hospitals, patients, and families a more caring and efficient protocol for everyone involved.

Six strategies for reducing patient no-shows

Posted on: 09.03.15

Patient no-shows aren’t just frustrating, they cost you time and money. Every practice would love to reduce no-shows, but the big question is, how? We’ve put together six practical tips you can use to discourage and reduce your number of no-shows.

1. Ownership

It’s important for patients to feel some responsibility in keeping their appointment. Having them sign a written no-show policy is a way to create a greater sense of ownership. You can also consider charging for no-shows and same-day cancelations, unless it’s an emergency, of course. Requiring a signed notice is a smart way to ensure your patients are informed of the policy and will help avoid confrontation if it’s enforced.

2. Transportation

Do you have any helpful information regarding public transportation? Maybe the bus route changes on certain days or there’s a special event in town that will impact traffic. Try not to schedule your imaging on the days it is difficult for patients that take public transportation to your office. It’s also helpful to have contact information for alternate forms of transportation, such as Uber or a taxi service should a patient’s ride fall through.

3. Education

Nuclear imaging patients need to clearly understand, in advance of the appointment, that the materials used for their test are individually ordered and that they must be used within a specific window. Patients need to understand that the isotope cannot be used on the next patient and will expire if they miss their appointment.

4. Say Thanks

A good way to reduce no-shows is to encourage the behavior you want and then reward it. A monthly gift card drawing for patients who kept their appointments is a simple way to say thanks. Also, don’t forget to thank patients who reschedule in advance of your no-show policy.

5. Timeliness

Work towards accurate scheduling so patients aren’t experiencing extra long wait times. When patients believe the practice doesn’t value their time, they will not value yours. Emergencies happen, “work-ins” are sometimes necessary, but be sure you make every effort to stay on time. Running too far behind? Consider calling patients to explain and asking them to come in 30 minutes later. They may be able to stay at work a little longer or run a quick errand.

6. Follow Trends

It’s critical to track the reasons patients offer for canceling an appointment. Spotting trends in the reasons provided can help you find ways to fix the no-shows. It could be tracked down to a particular insurance carrier, a day of the week, or physician. Identifying this information can impact your bottom line.

Bonus tip:

Explore new ways to notify and remind your patients with tools like texting or e-mailing appointment reminders. Utilizing the technology your patients interface with every day is a sure-fire way to reach them.

Atrial Fibrillation Detection and Cryptogenic Strokes

Posted on: 08.27.15

One-third of stroke and transient ischemic attacks are categorized as having no known cause, or cryptogenic. Recent studies have suggested that atrial fibrillation (AF) could be a possible cause for these cryptogenic strokes. If atrial fibrillation is known or suspected, early detection and monitoring is key.

In a study reported in The New England Journal of Medicine, patients without known atrial fibrillation, who had had a cryptogenic ischemic stroke, were monitored by mobile telemetry for 30 days. The study concluded that 12-15% of strokes were possibly caused by atrial fibrillation and raised the importance of early detection.

In addition to MCT, implantable loops are a new alternative that have also proven effective. These implantable cardiac monitoring systems are particularly useful either when symptoms are infrequent or when long-term data is required.

Based on the NEJM study, the use of mobile cardiac monitoring to detect and manage atrial fibrillation can also reduce a patient’s risk for stroke. Early detection is critical to identifying preventive treatment before an AF-related stroke occurs.

ASNC 2015 Annual Meeting

Posted on: 08.20.15

This year, the American Society of Nuclear Cardiology will host its 20th Annual Scientific Session from September 17^th through the 20th, 2015 at the Washington Marriott Wardman Park Hotel in Washington, D.C.

“This is the premier meeting for nuclear cardiology, one that you won’t want to miss,” said Kathy Flood, CEO of ASNC. Physicians, scientists, technologists, nurses and colleagues from around the world will join us for this highly anticipated, educational event. This year’s meeting will address the ways in which nuclear cardiology is making its mark in the industry. It will highlight many of the exciting, cutting-edge, scientific developments, discuss the changing healthcare environment and update you on the latest health and regulatory policy.

“ANSC’s 2015 meeting format has been designed to be more dynamic and diverse than in previous years, making time away from your practice a valuable and worth-while experience,” said Flood.

Exclusive Events

The program includes some exclusive opportunities this year, like Capitol Hill Lobby Day. On September 17^th, you can make your voice heard by joining fellow ASNC members on Capitol Hill for a half-day program dedicated to advocacy, education and lobbying. This session also includes pre-arranged meetings with congressional lawmakers and staff where you can introduce yourself and your profession to the ultimate decision makers.

The Referring Clinical Satellite Symposium is a unique program specifically geared toward the referring clinicians. It’s designed to help gain competence in ordering cardiac imaging procedures, to know when to apply appropriate use criteria and guidelines and to make it easy and clear when ordering nuclear cardiology imaging studies.

“Can’t Miss” Sessions

So You Think You Want to Start a Cardiovascular PET Program…
Health Care Reform: The New Environment Training and CE for NC Laboratory Staff: Insights from the IAC
Use of Multimodality Imaging Following Nuclear Imaging: When is it Helpful?
Imaging Arrhythmogenesis: Bringing Nuclear Cardiology to the EP Lab
Volume to Value: Politics, Economics and Practice Aspects
I have Old SPECT Camera and Want an Upgrade: Options and Costs?
Debates: Class of the Giants –PET/MR Cutting Edge Technology or a “White Elephant”
Special Breakfast Symposium “AUC: Debating the Right Patient, Right Test at the Right Time”

Digirad is thrilled to be among the exhibitors at this year’s meeting. Look for us in the center of the Exhibit Hall in Booth #410 where we’ll be showcasing the Cardius® X-ACT dedicated cardiac SPECT imaging system with Attenuation Correction and our administrative services programs, designed to maximize the quality, efficiency and profitability of your Nuclear Cardiology lab.

For more information, visit the ASNC website.

Imaging Industry News – August

Posted on: 08.06.15

Heart Attack Symptoms and Heart Disease Prevalence in Women

Heart disease is often recognized as man’s condition, but, according to the American Heart Association, heart disease is the number one killer of women, causing one in three deaths each year. New York cardiology practice, Long Island Heart Associates with its strong emphasis on heart disease prevention, strives to bring awareness to women regarding heart disease. Continue reading…

Digirad Announces That It Has Completed Its Strategic Partnership and Investment Into Perma-Fix Medical

Digirad Corporation recently announced that it has completed its previously announced strategic partnership and investment into Perma-Fix Medical S.A., the Polish subsidiary of Perma-Fix Environmental Services, Inc. Under this partnership, Digirad invested $1 million into Perma-Fix Medical S.A. As part of the partnership and investment, Digirad appointed Matt Molchan, President and CEO of Digirad Corporation, to Perma-Fix Medical S.A.’s Supervisory Board. Continue reading…

New Biomarker, Therapeutic Target For Breast Cancer Identified

Researchers have discovered a molecule present in basal-like breast cancer, or BLBC, tumors that allows them to be detected, and when its presence was reduced in cancer cell models the tumors’ growth was slowed significantly. “This discovery offers a glimmer of hope for patients stricken with BLBC. Personalized cancer therapies could be developed by targeting breast cancer cells that express copious levels of IL13RA2,” said Dr. Sam Thiagalingam, an associate professor Boston University School of Medicine, in a press release. Continue reading…

Pitt Scientists Lead Consensus Guidelines for Thyroid Cancer Molecular Tests

University of Pittsburgh Cancer Institute scientists recently led a panel of experts in revising national guidelines for thyroid cancer testing to reflect newly available tests that better incorporate personalized medicine into diagnosing the condition. Their clinical explanation for when to use and how to interpret thyroid cancer tests is published in the July issue of the scientific journal, Thyroid. Continue reading…

Emory Study Focuses On Heart Health Of AJC Peachtree Road Race Runners

Researchers at the Emory University School of Medicine are teaming up with the Atlanta Track Club to study the effects of exercise on the heart. The goal of the study, locally referred to as Promoting Endurance Exercise in Atlanta for Cardiac Health (PEACH), is to assess the impact of age, gender and fitness level on cardiac function after completing a moderate, but exhaustive, endurance-exercise event. Continue reading…

Understanding Your Cost Per Study

Posted on: 07.30.15

What is your cost per study? It’s a simple question, and the answer may be higher than you think. There are multiple factors to consider when calculating an accurate cost. So how do you know? Let’s take a look:

Your cost per study is driven by six key factors:

STAFF – What is your annual cost to employ your team
of nuclear medicine technologists, cardiac stress technicians, billing and
other support staff?
EQUIPMENT – Consider your initial investment as well as
the annual depreciation of your myocardial perfusion imaging system.
MAINTENANCE – If you have a service agreement, include the
annual cost. If not, calculate an average annual maintenance expense.
LICENSING – What are your annual expenses associated with
acquiring and maintaining all necessary licenses and certifications? How
much is your annual spend on Radiation Safety Programs, as well as
Radiation Physics Audits and Consultation?
ACCREDITATION – If your practice is accredited, what was the
cost of preparing for and now maintaining that accreditation?
SUPPLIES – Include any initial and recurring cost of
general medical supplies, radiopharmaceuticals, and pharmacological stress
agents.

Add your initial investment (adjusted for depreciation) and ongoing annual costs and divide it by your annual study volume. The resulting number is your cost per study.

Are you surprised by your cost? Is it higher or lower than you expected? An outsourced nuclear imaging solution, like Digirad Select, may be a more cost-efficient option. Gathering your costs can be an intimidating task, but knowing your cost per study is a critical metric for any practice that provides imaging.

Does it make sense to outsource nuclear cardiology?

Posted on: 07.23.15

Whether you’re operating an existing practice or preparing to open a new one, outsourcing your nuclear cardiology is an option worthy of consideration. Not only can it afford conveniences and benefits to your patients, outsourcing could be a smart decision for the overall health of your practice as well.

Four advantages of outsourcing:

COST: Through an outsourcing service, you
are given access to an advanced, solid-state nuclear imaging system. These
systems are designed specifically to meet the standards of nuclear
cardiology. This alleviates the burden of maintaining and continually
upgrading your aging equipment.
SERVICES: Outsourced services are designed to
be flexible and accommodating. The frequency of imaging is customized to
meet the needs of your practice. You’re never committed to a fixed number
of studies and only invest in the staff you need.
STAFFING: An outsourced staff should consist
of highly qualified and certified technologists, all of whose credentials
are monitored and kept current through continuing education. Plus, you
only need to invest in staff when and where you need them.
ACCREDITATION: Choose a nuclear imaging outsourcing
partner that provides accreditation as a part of the service. With this
feature, you don’t have to apply for or maintain your own accreditation.

Not only is outsourcing your nuclear cardiology cost efficient, it will increase your patients’ satisfaction and overall experience. It could be the step that takes your practice to the next level.

Digirad provides an outsourced nuclear lab solution through our Digirad Select program. If you’re interested in more information on Digirad Select, click here.

Accreditation Timelines

Posted on: 07.16.15

No one looks forward to an audit, but it’s required triennially to ensure continued IAC or ACR accreditation for your practice. Because maintaining your accreditation is of such great importance, the reaccreditation audit can be extremely stressful. To help manage the pressure and avoid a lapse in your accreditation status, you’ll need to have a plan, start early, and stay organized. Here is a general timeline during your three-year accreditation term to help keep you on schedule.

1st year of Accreditation:
□ Physicians and Technologists should be earning CMEs and CEUs.
□ Perform annual update of policy and procedures.
□ Schedule two quality improvement meetings.
□ File a copy of the recorded meeting minutes.

2nd year of Accreditation:
□ Physicians and Technologists should be earning CMEs and CEUs.
□ Perform annual update of policy and procedures.
□ Schedule two quality improvement meetings.
□ File a copy of the recorded meeting minutes.

3rd year of Accreditation:
□ Physicians and Technologists should be earning CMEs and CEUs.
□ Perform annual update of policy and procedures.
□ Hold two quality improvement meetings.
□ File a copy of the recorded meeting minutes.

□ 8 months prior to renewal date, begin gathering information and documentation

□ 6 months prior to renewal date, your online application will be unlocked and you can begin entering information and uploading documents

□ 4 months prior to renewal date, submit your application for reaccreditation

□ 3-0 months prior to renewal date, monitor your email regularly. You will receive a notice of approval or a detailed notice of non-compliance.

Any notice of non-compliance will be time sensitive. Be conscious of deadline dates.

Within 30 days of notice:
□ Submit your corrective action plan for all deficient items noted.

Within 60 days of notice:
□ Submit evidence that your corrective action plan was implemented.

How do I implement a low-dose protocol?

Posted on: 07.09.15

Any time a physician orders a nuclear imaging scan, there is always concern about radiation exposure. Thankfully, today’s technology is making it possible to reduce that exposure in appropriate cases. If you are considering the implementation of a low-dose protocol, you’ll need to evaluate three major issues within your practice: proper patient segmentation, commitment, and technology.

Patient Segmentation

Commitment

Technology

With a low-dose protocol, the goal is to acquire an image with sufficient quality for maintaining diagnostic accuracy. Maintaining image quality while reducing the patient dose is a challenge but new technology makes it possible. A multi-head camera, combined with nSPEED reconstruction software and Tru-ACQ Count Based Imaging provides fast acquisition times with the lowest appropriate dose. These technological advances will help you establish a low-dose protocol, all while keeping the safety of the patient as the top priority.

Here are links to additional resources supporting a low-dose protocol:

Image Wisely Campaign

ASNC Low-Dose Guidelines

Strategies for Meeting the ASNC Imaging Guidelines

Industry News

Posted on: 07.02.15

The imaging industry is continually evolving and it’s important to stay informed about the changes that may impact the development, operation, maintenance, and growth of your imaging services. Here are some important developments and updates:

Managing Patient Radiation Burden in Cardiac Imaging

Nuclear myocardial perfusion imaging (MPI) with positron emission tomography (PET) and single-photon emission computed tomography (SPECT) have been the gold standard for non-invasive detection of coronary ischemia and infarcts. However, the high radiation doses patients receive are making some providers think twice before referring their patients for nuclear MPI. Read more…

CMS Finalizes Medicare ACO Rule

The Centers for Medicare & Medicaid Services (CMS) has released a final rule updating the Medicare Shared Savings Program (MSSP). The rule aims to encourage the delivery of high-quality care for Medicare beneficiaries and build on the early successes of the program and of the Pioneer accountable care organization (ACO) model. Read more…

Open Payments Program Increases Transparency in Health Care

The Centers for Medicare & Medicaid Services’ (CMS) Open Payments program collects data from drug and device manufacturers and group purchasing organizations (GPOs) about payments they make to physicians and teaching hospitals as well as reports physician ownership interests in drug and device manufacturers and GPOs. It’s important that physicians and teaching hospitals confirm the accuracy of the financial relationships reported about them. Read more…

Now Available — The ASNC ImageGuide™ Fact Sheet

ImageGuide™, the nation’s first cardiovascular nuclear imaging data registry was recently introduced by the American Society of Nuclear Cardiology. Highlighting the data collection and the overall benefits of the registry is the newly released fact sheet.

View Heart Rhythm’s 36th Annual Scientific Session Abstracts

Through more than three days of learning, physicians, allied health care professionals, and scientists came together in May at Heart Rhythm 2015 to learn about innovations in science, education, and technology from the world’s most noted experts on heart rhythm disorders. If you weren’t able to attend, you can still view the 2015 abstracts here.

How to get high quality nuclear images when imaging obese patients

Posted on: 06.25.15

Imaging obese patients often presents a unique challenge for medical providers. It can be difficult and sometimes impossible to accommodate larger patients based on their size and the limitations of certain equipment.

Aside from the maximum weight threshold, a major obstacle of many nuclear gamma cameras is their fixed detector design, which hinders the acquisition of quality images in this patient population. Because of the fixed geometry of these systems, there is a limit to where the detectors can be positioned for viewing, which can easily move the heart out of the “sweet spot” field of view.

Effectively imaging obese patients requires equipment that is cardio-centric. A camera that features a variable radius, which keeps the heart in the field of view, eliminating truncation, is ideal. Incorporating advanced iterative reconstruction provides the ability to acquire appropriate counts for the image with reduced scan time. Additionally, attenuation correction further benefits imaging obese patients as it improves image quality and interpretive accuracy.

Digirad has designed nuclear cameras that effectively address these issues. The Cardius® XPO Series and X-ACT cameras include a higher than average weight capacity, supporting up to 500 pounds, nSPEED™ 3D-OSEM reconstruction software, and TruACQ Count Based Imaging™. The X-ACT also includes fully integrated Fluorescence Attenuation Correction for improved diagnostic confidence. Most importantly, Digirad’s dedicated cardiac cameras feature variable geometry with an upright rotating chair and camera heads that move in and out while continuously keeping the heart in focus.

A camera with a variable radius is invaluable in optimizing the imaging of obese patients. For more information or a demonstration of these features, contact Digirad’s camera team.

HHS Sets Goals for Medicare’s Alternative Payment Models

Posted on: 06.18.15

After meeting with key healthcare industry officials in Washington earlier in the year, Health and Human Services (HHS) has identified specific goals and established concrete deadlines for overhauling the Medicare payment system, which has traditionally operated under the standard fee-for-service model.

The Obama administration is committed to securing 30% of payments for traditional Medicare benefits from alternative payment models, such as Accountable Care Organizations (ACOs), by the end of 2016 and 50% of those payments by the end of 2018. Since the existing ACO program began in 2011, HHS credits it with an estimated $417 million reduction in Medicare spending.

“We believe these goals can drive transformative change, help us manage and track progress and create accountability for measurable improvement,” HHS Secretary Sylvia Mathews Burwell said in a statement announcing the targets.

When do I use Holter, Event Monitoring, or Mobile Telemetry?

Posted on: 06.11.15

When a patient reports symptoms of an irregular cardiac event, physicians can choose to monitor cardiac activity using a Holter monitor, cardiac event monitor, or mobile cardiac telemetry.

Holter monitors are often a physician’s first line of defense when a patient reports symptoms of a cardiac irregularity. They are a non-invasive, wearable device that records the patient’s heart rhythm for a prescribed period of time during which the patient assumes normal, daily activities. Although it may be a low-cost, low-risk option, many physicians report non-diagnostic rates as high as 85%. Most often, this is because symptoms may not reappear in the 24 to 48 hours during which the Holter is monitoring the patient’s heart rhythm.

A cardiac event monitor is another option and is often the next line of defense. Typically worn for 30 days, it is prescribed for patients whose symptoms occur infrequently. When the patient experiences an abnormality, he manually presses a button to record the preceding and following five minutes of the event. There may also be an auto-capture feature where the device records the information even if the patient is unaware of the activity. Advances in the technology now allow for the wireless transmission of the data via the cellular network. These newer devices also have enhanced programming and expanded storage capabilities. Cardiac event monitors store the recorded data, which is ultimately transmitted either to a physician’s office or to a central recording station.

Mobile cardiac telemetry is the newest of the monitoring options. MCT devices are small portable monitors that, when a cardiac anomaly is detected, automatically send data. MCT devices provide even more information such as AFIB burden. The data is transmitted to a 24-hour manned monitoring center via a mobile network, and then interpreted by a qualified, cardiac-trained registered nurse. In contrast to the cardiac event monitor, MCT provides real-time monitoring and analysis.

There are no official guidelines established for deciding which monitoring method is best for your patient; however some insurance companies have specific criteria for the use of Mobile Outpatient Telemetry. MCT devices have proven beneficial in patients with unexplained syncope, Cryptogenic Stroke and post ablation.

2015 Nuclear Cardiology Industry Benchmark Report Launches

Posted on: 06.04.15

Digirad, in partnership with Medaxiom, has released the 2015 Nuclear Cardiology Industry Benchmark Report. The report tool offers users an unbiased evaluation of where their organization stands relative to nationally gathered data from other practices across the United States.

Using data compiled and supplied by Medaxiom, one of the most well respected organizations of cardiologists in the nation, the benchmark reporting tool compares factors including new patient consults, study volume, number of cardiologists and the average camera age. In addition to providing a series of benchmarks, the report also delivers potential risk factors and quality and cost savings opportunities that could impact your practice in the future.

The first step in improving the performance of your practice is knowing where you stand. Visit www.digirad.com/report to take advantage of this free reporting tool to see what steps you can take to optimize your cardiology practice.

What to do if you fail an IAC audit

Posted on: 05.28.15

So you failed an audit…

During each period of accreditation, your practice will be subjected to an audit by the IAC. You should expect a notice of audit, via email, at any time during this period. Be sure to have a valid email address on file, one that is monitored regularly. Once the audit is complete, you’ll receive approval or a time-sensitive notice regarding your non-compliance.

It’s important to avoid your accreditation from lapsing, so throughout the accreditation period, it’s critical that you stay organized and on track. Proactive planning and implementing appropriate processes and controls will assuredly minimize your risk of a failed audit.

If you receive notification of a failed audit, there are generally three steps to follow:

Read the letter carefully. You will need to respond to each deficiency. Common areas of non-compliance include substandard execution of quality improvement meetings and documented meeting minutes, patient reporting, required policies, quality control and physician CME documentation.
Submit your corrective action plan within 30 days. Be sure to provide detailed actions for each violation.
Submit documentation of the completed action within 60 days. You will have exactly 60 days to implement your corrective plan, and you must provide the appropriate documentation as evidence of having done so.

No one wants to fail an audit, but thankfully there is a process to address any issues. Act quickly, be conscious of deadlines and start planning now for the next one.

Radiology Benefit Managers Merge

Posted on: 05.21.15

CareCore National and MedSolutions, two leading providers of Specialty Benefits Management (SBM) services who contract with private insurance companies to manage their healthcare costs, have merged. At the current time, the new company is continuing to operate under both the CareCore and MedSolutions brands.

Utilizing evidence-based protocols, the consolidated Radiology Benefit Manager’s (RBM) objective is to ensure “the right evidence-based care is delivered at the right time to the right patient at the right site of care.” Managing the skyrocketing healthcare costs is a growing issue that needs attention, but the mixed results in controlling medical costs have attracted controversy and concerns about whether RBMs are helping or hindering the process.

Although the new company has not formally announced or implemented any modifications to current clinical criteria, there have been providers who are already reporting an increase in peer-to-peer reviews and denials for approvals when the office performing the scan is not an approved specialty.

The merger of CareCore National and MedSolutions has resulted in now only four RBMs managing access to care for 85% of all lives subject to review.

2015 SNMMI Annual Meeting

Posted on: 05.14.15

Visit us at Booth 635!

This year’s Society of Nuclear and Molecular Imaging (SNMMI) Annual Meeting, the highly anticipated, scientific, research, and networking event in nuclear medicine and molecular imaging, will be held in Baltimore, Maryland, from June 6–10, 2015.

The diverse city of Baltimore, known for its beautiful inner harbor and distinct neighborhoods, is also home to the world-renowned Johns Hopkins Hospital and the University of Maryland Medical Center. It’s the perfect destination for more than 4,000 members of our profession.

Explore the latest technologies, witness ground-breaking new products and services, and connect with the companies that make it happen. SNMMI’s Exhibit Hall will showcase more than 160 of the industry’s top nuclear medicine and molecular imaging product and service providers. Interact with the vendors who drive innovation and help you disseminate the information to make the best decisions about products and services for your practice.

Digirad is proud to be exhibiting our Cardius® X-ACT and Ergo™ Imaging System at the 2015 SNMMI Annual Meeting. You can find us at Booth 635. Click here to view the exhibit map.

Make sure to stop by and see us!

Important Appropriate Use Criteria (AUC) changes on the horizon

Posted on: 05.07.15

Effective January 2017, Medicare will require providers to consult physician-developed Appropriate Use Criteria (AUC) and formally document their consultation prior to ordering a diagnostic imaging test. Although the burden of proof falls on the referring physician, it will also impact payment to the imaging physician if they are not one in the same.

The changes are designed to:

Encourage evidence-based medicine
Ensure indicated tests are performed on the appropriate patients
Avoid duplication and reduce costs
Use healthcare resources more efficiently
Create greater patient outcomes

The specific AUC guidelines are due to be released by Centers for Medicare and Medicaid Service (CMS) no later than November 2015. Clinical decision-support tools designed to help navigate AUC are to be identified by Health and Human Services (HHS) by April 1, 2016. However, exactly how the process of documentation will be implemented into daily practice remains to be seen. For more information on the on the upcoming changes, here are some additional resources:

Understanding Appropriate Use Criteria in Nuclear Medicine

ACCF/ASNC Appropriateness Criteria

CMS to Require Appropriate Use Criteria Consultation

New Law Mandates Use of Imaging Appropriateness Criteria

CMS to Require Appropriate Use Criteria Consultation

New Law Mandates Use of Imaging Appropriateness Criteria

Where/how to get Nuclear Medicine CME’s

Posted on: 04.30.15

Physicians and technologists generally have an abundance of credits; however, the credits must be specifically relevant to nuclear medicine. This is an incredibly important detail that many practices overlook, and many times is the reason a practice is cited for non-compliance.

Starting the continuing education process early-on is crucial so that physicians and technologists will have enough time to complete the appropriate number of courses. One CME/CEU is equal to 1 hour, so each staff member can expect to dedicate 15 hours per 3-year accreditation period earning these credits.

Here are some quick links if you’re looking for more information on where to find CMEs and CEUs
Upcoming CME Courses (IAC)
Recurring Courses and Self Study (IAC)
Online CME Courses (IAC)
eLearning Sources (ACR)
Board Vitals

Sustainable growth rate repealed

Posted on: 04.23.15

On April 16, 2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015. The new law repeals Medicare’s sustainable growth rate (SGR) formula for physician pay and will ultimately move the Medicare program from fee-for-service to pay-for-performance. Although the specific components must still be defined, the law will have a major impact on the medical community.

Doctors who were facing the 21% SGR-triggered rate reduction will now receive a stable annual payment increase of 0.5% in each of the years 2015 through 2019, beginning July 1, 2015.

Additional financial incentives will be available for those doctors who take advantage of approved alternative payment models (APMs). The specific APMs have not yet been identified.

Several of the Medicare Quality Reporting programs (PQRS, VBPM & MU) will be combined into a new program called the Merit-Based Incentive Payment System (MIPS).

The use of 10- and 90-day global surgical codes in Medicare will be reinstated.

Signing the largest healthcare bill since 2010, President Obama was optimistic and eager to see these historic reforms put into action. “It starts encouraging payments based on quality, not the number of tests that are provided or the number of procedures that are applied, but whether or not people actually start feeling better,” he said.

Non-diagnostic Holter, Symptomatic Patient…Now What?

Posted on: 04.16.15

When a patient expresses symptoms or exhibits signs of a cardiac irregularity, many cardiologists look to the Holter monitor as their first line of defense. While Holter monitors can be effective, it’s not uncommon for them to be returned as non-diagnostic. In fact, many physicians report non-diagnostic rates as high as 85%. Most often, this is because symptoms may not reappear in the 24 to 48 hours during which the Holter is monitoring the patient’s heart rhythm. Non-diagnostic Holters are also known as a benign Holter or a negative Holter.

Non-diagnostic results… now what?

Cardiac irregularities should not be dismissed even when a cardiologist receives a non-diagnostic Holter. The suspicion of an arrhythmia warrants additional steps. Many cardiologists will prescribe the use of a Holter monitor for a longer period. If the patient’s condition is infrequent, or if the patient is asymptomatic, then a passive recording system could be a more appropriate choice.

Some recording systems can be activated by the patient when he or she becomes symptomatic. Other systems utilize a Mobile Cardiac Telemetry (MCT) device that continually transmits EKG data back to a staffed monitoring center. If an abnormality is detected, the system will create an event and generate a report which documents the irregularity with full onset and offset as well as comprehensive ectopy reporting.

Many physicians who do not own a Mobile Cardiac Telemetry system choose to utilize a service-based cardiac monitoring provider, such as Telerhythmics. A cardiac monitoring service company can allow you to offer the technology without having to purchase the equipment. Plus, if you’ve never used a Mobile Cardiac Telemetry system, they will teach you how it works and train your staff on how to provide the service.

As always, regardless of which technology or service you choose, it’s most important to continue monitoring the patient until a diagnosis can be made.

Mayo Clinic Endorses Molecular Breast Imaging

Posted on: 04.09.15

A Better Way of Detecting Breast Cancer

Recently, Mayo Clinic, one of the gold standards in the medical world, announced that Molecular Breast Imaging (MBI) will be their preferred supplemental imaging technology, in addition to mammography, for women with dense breast tissue. In a recent interview, Dr. Michael O’Connor of Mayo Clinic, inventor of the MBI technology, discussed how that major decision came about and how impactful this technology will have in the imaging world. “This is the beginning of a new era for molecular imaging of the breast, and I think it’s a very exciting time for us,” he said.

MBI has excellent specificity, gives very few false positives, and has a low recall rate. Most impressively, it nearly quadruples detection rates of invasive breast cancers in women with dense breast tissue.

Mayo Clinic has been the pioneer of this technology. After ten years and two large screening trials, they have had the experience and benefit of working with the technology. They were comfortable “jumping in” and have embraced it fully. It will take a few more years before it disseminates across the country and into smaller clinics, but the progress thus far has been remarkable.

Additional Resources

Watch the full interview with Dr. Michael O’Connor here.

To read Mayo Clinic’s official press release, click here.

To listen to Dr. Deborah Rhodes of Mayo Clinic comment on the results of a major recent MBI study, click here.

April Imaging Industry News

Posted on: 04.02.15

The imaging industry is continually evolving and it’s important to stay informed about the changes that may impact the development, operation, maintenance, and growth of your imaging services.

Medicare to Shift 50 Percent of Payments to Alternative Models by 2019

Half of Medicare’s provider payments will come through alternative payment models within four years, according to goals the Obama administration announced Jan. 26. The initiative would expand the roughly 20 percent of Medicare payments that were made through alternative payment models and population-based payments in 2014 to 30 percent by the end of 2016 and 50 percent by the end of 2018. Continue Reading…

When Hospitals Buy Doctors’ Offices, and Patient Fees Soar

Imagine you’re a Medicare patient, and you go to your doctor for an ultrasound of your heart one month. Medicare pays your doctor’s office $189, and you pay about 20 percent of that bill as a co-payment.Then, the next month, your doctor’s practice has been bought by the local hospital. You go to the same building and get the same test from the same doctor, but suddenly the price has shot up to $453, as has your share of the bill. Continue Reading…

Economic Changes Affecting Your Bottom Line

March 23, 2015, marks the fifth anniversary of passage of the Affordable Care Act into law. As the health care marketplace continues its transition into a new normal of payment methods, key economic terms such as “risk” have now become paramount concepts for providers to not only understand, but embrace and incorporate into their business and clinical strategies. Continue Reading…

Cardiac PET/MR: Big Footprint—Small Step?

Modern imaging seems unthinkable without the tremendous developments of the last few decades. While the future of Radiology seems to be in molecular imaging based on novel tracers, the present is unimaginable without the past technical evolution. As the footprints got bigger with the devices growing from simple gamma cameras to SPECT, PET, and finally hybrid scanners, the steps in medical imaging achieved by these advancements were of variable size. Continue Reading…

FDA makes official its hands-off approach to regulating health apps and medical software

The Food and Drug Administration issued its final guidance on the regulation of health apps and other software, and health tech developers should be breathing a sigh of relief. The FDA confirmed that it’ll take a hands-off approach to most medical device data systems (MDDS), or software that conveys data to and from a medical device (like a glucose meter, for example). Continue Reading…

ICD-10 Update: What You Need to Know

Posted on: 03.26.15

Updating to ICD-10 will give medical practices, insurance companies, and health organizations more than 16,000 codes to use when billing and coding their services. Providing medical practices with a more detailed medical snapshot will improve patient health and ease procedures at the medical and administrative levels. For a more in-depth look, review our previous post outlining the details of ICD-10 here.

What’s Happening Now?

Despite multiple efforts to delay the start date, implementation of ICD-10 is slated to begin on October 1, 2015. This update will bring a big change, and it requires work up-front to ensure that implementation transitions as smoothly as possible. Some medical practices, insurance companies, and health organizations are resisting this training and implementation effort because they fear the hassle. However, with preparation and training, switching to ICD-10 can be a seamless process.

What Do I Need to Do?

With an October implementation date on the books, it is smart to begin preparing for the switch. This means gaining knowledge on how ICD-10 works, and how to use it.

There are training materials provided on the AAPC and Decision Health websites. In addition to these resources, the World Health Organization (WHO) website provides detailed ICD-10 information. ICD-10-specific materials, such as a browser, training, and study guide, are available for download. The American Medical Association (AMA) also provides a helpful service to its customers called Find a Code.

Once you and your staff are knowledgeable of what changes ICD-10 will bring, start to update your guides, forms, and billing systems. Keep an eye out for updates and need-to-know items concerning ICD-10 implementation on the Digirad website.

Finding the right scan time, every time, with TruACQ Count Based Imaging™

Posted on: 03.19.15

Missing the mark on scan times can result in a lower quality image or an unnecessarily increased dose to the patient. Each patient has a different height, weight, and size, which all impact the scan time and image quality. Technologists utilize their experience to estimate the ideal scanning time, but it is still a bit of a guessing game.

What if there was a way to precisely calculate the scan time based on the injected dose? Digirad’s TruACQ Count Based Imaging™ software provides that solution.

A Personalized Scan

TruACQ Count Based Imaging™ is the first and only count-based SPECT imaging technique that ensures consistent counts for every patient study, regardless of the patient’s size, weight, or the dose used. This proprietary software is designed to simplify the decision-making process around acquisition time. TruACQ™ takes a quick look at exactly what the detectors are picking up, which accounts for all possible variables, and provides the optimal scan time for the patient being imaged. The result is the highest quality image in the shortest amount of time. TruACQ™ is used on each scan, creating a scan that is personalized to fit the patient’s unique body.

Why It Matters

TruACQ™ is designed to base the required count level on the American Society of Nuclear Cardiology (ASNC) standards. The ANSC low-dose guidelines are designed to minimize radiation exposure without sacrificing quality or clinical benefit to the patient. Undoubtedly, lower radiation exposure is safer for patients, and low dose protocols are becoming more widely implemented. In fact, low-dose standards may eventually become a requirement for reimbursement. However, under-dosing could result in lower quality images, which could compromise the study interpretation, resulting in additional scans or an overlooked diagnosis.

TruACQ™ and Digirad

TruACQ™ is Digirad’s proprietary software solution only available on Digirad Cardius® cameras. To learn more about how TruACQ™ determines scan time, contact our imaging team for a demonstration.

8 Questions To Ask Before You Sign A Service Contract

Posted on: 03.12.15

When you invest in your medical practice by purchasing your own imaging equipment, it is imperative your asset is well maintained and working properly. Purchasing a service contract for your camera protects your investment, and it ensures that your camera produces quality images to reliably assist in patient diagnosis. Proper maintenance of your camera is important to the vitality and efficacy of your practice, and required for accreditation and reimbursement. Service contracts provide you with the peace of mind knowing your equipment will be operating effectively, and in case of emergency malfunctions, a knowledgeable, well trained team will be ready to assist you.

Before you select a service provider, it’s important to know the right questions to ask about a service contract. Ask the potential provider these eight questions to make sure that you get everything you need from your service contract.

Before committing to a service contract, request the coverage contract in writing. Be sure to ask what the provider includes in a “full-service contract.” If the contract doesn’t cover all the camera parts and service, ask for a list of what is not covered. Typically, service providers do not cover external damage to the camera, and in some cases will not cover glass (crystal, PMTs, etc).

2. What is the coverage area?

Ask your service provider about the coverage base: is the provider a national or a local company? If your camera falls outside of their coverage area, will you have to pay a travel charge? Looking ahead into possible charges or additional paperwork will save you time and money, and if you are comparing multiple vendors, it could help with the selection process.

3. Does the contract include preventative maintenance?

Ensure your coverage plan meets the state’s regulations for maintenance of the equipment. Ask your service provider if the contract includes adequate (OEM recommended) preventative maintenance, which is required for accreditation and reimbursement.

4. What is the guaranteed uptime?

To be an effective investment, your camera must be available for operation when you and your patients need it. Service providers often promise a percentage of “guaranteed uptime” in their service contracts. Make sure you select a service provider that you are confident will provide you a high “guaranteed uptime.”

5. Who will be supporting my equipment?

Ensure that the personnel maintaining and repairing your equipment are specialists who have a detailed understanding of the equipment and receive continuous training to keep up with manufacturer updates and recommendations. Talk to your service provider to ensure that they are qualified to work on the specific system. You want personnel who have experience working with nuclear equipment and understand HIPAA requirements. Personnel working on your systems should be knowledgeable, well trained, punctual, diligent, and communicative.

6. What type of remote support is available?

Many support issues can often be resolved via remote support. Ask your service provider if remote support is available and what their hours of operations are. Also, be sure remote support covers both the equipment and software applications. When remote support is available for your entire system, the amount of downtime is decreased providing continued quality care to your patients.

7. How quickly can I expect repairs?

Talk with your service provider to find out what the typical response time is when requesting repairs. Ensure that these time frames are included in the contract so that excessive downtime doesn’t impact the productivity of your practice.

8. What updates or upgrades are included?

Often, cameras include software that can be updated and upgraded as technology changes. Ask your service provider if your contract allows for updates or upgrades. And make sure you know the difference between the two. If either of these is not covered in your contract, ask for update and upgrade pricing. It’s important your software is current; this will assist in acquiring quality images, in turn, helping you provide quality care to your patients.

Primary types of ultrasound tests provided by cardiac, vascular or internal medicine practices

Posted on: 03.05.15

Cardiologists, vascular surgeons, and internal medicine providers use noninvasive ultrasound technology in a number of different ways. We’ve compiled a list of the most common types of ultrasound that can be provided in the doctor’s office. Take a look…

Cardiac Ultrasounds

Cardiac ultrasounds are used to diagnose and analyze the blood flow and function of the heart:

Echocardiograms – (referred to as “echos”) are sonograms of the heart. Echos use two-dimensional and three-dimensional ultrasound to create an image of the heart, and Doppler is used to assess blood flow through the heart and vessels.
Stress Echos— use ultrasound to show how well the heart muscles are working and whether or not there is a decrease in blood flow to the heart during rest, and stress periods (typically from exercising on a treadmill). For those patients who, due to arthritis or other conditions, are unable to exercise, a Pharmaceutical Stress Echo may be performed, which uses a medicine injected into the patient intravenously to stimulate the heart as if the patient were exercising.
Contrast Echos—used to improve overall image resolution to show how well blood is flowing through the heart and the heart muscle. The contrast is provided by the use of an agitated saline solution or a contrast agent injected intravenously.

Vascular Ultrasounds

Vascular ultrasounds are used to analyze the flow of blood through the arteries and veins:

Carotid—Carotid ultrasound is a non-invasive procedure that examines the structure and blood flow of the carotid arteries in the neck to detect any plaque buildup within the arteries.
Upper and Lower Extremity Ultrasound—Ultrasound examination of the upper and lower extremities that analyzes for peripheral vascular disease.
Abdominal Vasculature Ultrasound—Vascular ultrasound is used to examine the function of the blood vessels and the flow of blood in the abdominal aorta, renal artery, and mesenteric arteries.
Vein Mapping—Venous mapping is used to map the veins of the patient’s legs in preparation for graft surgery or bypass surgery. Vein mapping also provides information for the treatment of varicose veins, deep vein thrombosis, leg swelling, and other conditions.

General Studies Ultrasounds

General studies ultrasounds are used for a variety of diagnostic purposes for the following organ systems:

Thyroid—Checks for underactive and overactive thyroid glands, nodules, and cysts.
Gall bladder—Provides a view of the structure of the gall bladder from different angles, and can be useful in the detection of cancer and gallstones.
Kidney—Determines the size, shape, and function of the kidneys, and can be useful in the detection of kidney stones, cysts, and tumors.
Liver—Determines the size, shape, and function of the liver, and can be used to detect tumors.
Pancreas—Determines the size, shape, and location of the pancreas, and can be used to detect tumors.
Pelvic—Provides a picture of the organs and structure in the lower belly.
Soft tissue—Helps evaluate infections of the soft tissue, including cellulitis, abcesses, masses, and fluid retention.

Mobile Ultrasound Services

Mobile ultrasound services are a way for you to offer a wider range of ultrasound imaging in your office. Digirad can supplement your existing staff and equipment or we can manage all of your ultrasound needs with our team of sonographers and equipment.

Medicare Physician Fee Schedule 2015 Update

Posted on: 02.26.15

With April fast approaching, it’s important to remember that April 1st marks the end of the Protecting Access to Medicare Act of 2014. On this date, Congress will respond to the expiration in one of three ways. Their options are to pass another year-long delay, propose a permanent solution, or let the provision expire altogether.

The permanent solution would be to eliminate the Sustainable Growth Rate (SGR) altogether. Eliminating the SGR would mean that healthcare cost neutrality would be achieved, benefitting providers and patients. However, the prediction of lobbyists who are concerned with this issue forecasts another temporary solution. In the current political climate, it is highly doubtful that a permanent solution will be adopted.

If a permanent solution is not proposed by Congress, they may approve another year-long patch as they have since 2002. This is problematic, as it causes uncertainty and discomfort for the healthcare community. However, postponing the issue for another year is a preferred outcome to no action. If Congress does not provide a solution, reimbursement rates will be reduced by as much as 22 percent.

Digirad will continue to monitor the legislation and present any changes that the legislation brings to our customers. You can do your part to stay up-to-date on the changes, updates, and announcements regarding this hot-button issue by following Digirad on LinkedIn and Twitter. You can also visit the following links to get involved:

When is mobile imaging better than ownership?

Posted on: 02.19.15

Imaging technology, guidelines, and payment models are changing for the cardiology field. Healthcare is moving from ‘fee for service’ to value. The choice between mobile imaging and ownership requires a detailed evaluation of the clinical and economic impacts of the two options. Many don’t realize that the cost of a SPECT Nuclear Cardiology camera (i.e., the monthly payment along with repair and maintenance) is NOT the most expensive aspect of owning and operating your own Nuclear Cardiology lab. It is the rest of the costs (see prior posting) that drive the total cost of ownership. Without substantial, consistent study volume and predictable, high reimbursements, these cost factors can not be spread over a large enough revenue base.

The following are some scenarios to consider when deciding if mobile imaging may be a better option over owning your own Nuclear Cardiology lab:

Are your reimbursements down? Are you relying on those payments to fund your fixed and variable ownership costs?
Do you have inconsistent patient volume from month to month, and are you unable to spread your fixed overhead costs evenly? Mobile imaging services allows you to scale your studies based on volume. You can pay-as-you-go with a known cost basis.
Are study volumes high enough to support all necessary costs, including consumables? Consider how many studies you plan to do each month.
Are you tight on space? Typically, newer technology demands less space than older technology. In addition, mobile imaging services do not require dedicated space. That means you can use that office space and increase productivity on the days or times that the mobile imaging services are not in your office.
Is your current technology older than five years? If so, are you able to invest in upgrades? Can you run today’s low dose protocols? Can you meet patient expectations, today’s quality standards, and current ASNC guidelines? Nuclear imaging equipment and quality standards are constantly advancing. With ownership, you run the risk of your equipment becoming obsolete before you are ready to upgrade. Mobile imaging allows you to upgrade to the most advanced equipment with no capital outlay by you.

It’s also important to consider mobile imaging options when opening a new practice or satellite location. You may not have the upfront capital available to invest in the necessary equipment, space, lab, licenses, accreditation, and labor. Or, you may want to use that capital to support other areas of your practice.

Mobile imaging gives you the benefit of the best technology for your patients without the high costs of owning your own lab.

Anthem cyberattack and HIPAA security – what you need to know

Posted on: 02.12.15

Recently, there has been a lot of focus on the safety of medical data due to the Anthem cyber attack. On February 5, it was discovered that Anthem, the second largest insurer in the United States, had been hacked. This was an aggressive attack that came from outside the organization. The massive data breach may have compromised the personal data of as many as 80 million people, placing them at risk of identity fraud.

If a large corporation like Anthem can’t protect its data, then many smaller practices are concerned that there is no way they’ll be able to protect theirs. However, you can and more importantly, you must protect your data. Whether you’re a small practice or a major corporation, everyone who works with protected health information has the same legal obligation to protect data under the Health Insurance Portability and Accountability Act (HIPAA) regulations. Here are some steps you can take to help ensure that your data is protected.

Encryption, Encryption, Encryption

The best way to ensure that your data is protected is through encryption. If the Anthem data was encrypted, the breach never would have happened the way it did. The National Institute of Standards and Technology (NIST) ( http://www.nist.gov) has established an encryption standard called the Federal Information Processing Standards (FIPS). This method provides four levels of security established to maintain the confidentiality and integrity of the data. This applies to data at rest and data in transit. Even if encrypted data is hacked, it will be unusable.

Review Your Business Associate Agreements (BAAs)

The second best practice to ensure that your data is protected is to establish proper contracts between your business relationships. These Business Associate Agreements (BAAs) are a contract between a HIPAA-covered entity and a HIPAA business associate that ensures that personal health information (PHI) is protected according to HIPAA guidelines. When you are creating a BAA, you need to ask who is acting as the covered entity and what is their relationship to the data. In addition, make sure all your BAAs are kept up-to-date, and use assurance questionnaires to ensure that your associates are doing everything they can to protect your business data.

Assess Your Liability

Anthem made the news because its breach involved 80 million records; however, data breaches occur every day. Smaller data breaches may not make the news, but they can still cause devastating consequences, and even small practices are subject to the same data protection rules. There are steep penalties for not complying with HIPAA regulations. The HIPAA Omnibus Rule enacted in 2013 places the same legal and financial burden on all companies that work with PHI, no matter the size.

What You Can Do

Don’t look at the big organizations and assume that they’re protecting data correctly. And, don’t assume that you don’t have to comply with the same standards as the big organizations. If your organization works with PHI, you and your staff need to understand how the rules affect your organization. If your internal resources cannot handle the task, consider using outside help. Digirad partners with Anaseed for its HIPAA compliance program, training, risk analysis and more, via the Live Compliance system (livecompliance.com). Anaseed assists organizations with encrypting data and attaining HIPAA compliance. For more information, visit http://www.anaseed.com

February Imaging Industry News

Posted on: 02.05.15

The imaging industry is continually evolving, and it’s important to stay informed about the changes that may impact the development, operation, maintenance, and growth of your imaging services.

ImageGuide Registry Launched by ASNC

The American Society of Nuclear Cardiology (ASNC) announced the launch of ImageGuide, the nation’s first cardiovascular nuclear imaging data registry. The registry is designed to ensure and optimize the quality of nuclear cardiac studies conducted in nuclear cardiology laboratories by interpreting physicians. Improving laboratory efficiency, optimizing patient radiation exposure, downstream cost minimization, and the improving patient care are among the goals of the registry. Continue Reading…

ASNC Names New President for 2015

On January 1^st, the ASNC’s newest president, Dr. David Wolinsky, took office. Wolinsky, Section Head of Nuclear Cardiology at Cleveland Clinic Florida, is considered a leader in the nuclear cardiology field. Wolinsky is a founding member of the ASNC, and he continues to work as an active teacher and lecturer at regional and national meetings. During his tenure, Wolinsky plans to focus on appropriate use criteria and maximizing the value of nuclear cardiology testing to provide high-quality, cost-effective cardiac care. Continue Reading…

Experts Say Money for SGR Fix Is Available

Many in the healthcare industry agree it’s time to replace the sustainable growth rate (SGR) formula for physician payments under Medicare. Previous efforts to repeal the SGR have failed mainly due to budgetary concerns, but offsetting the $140 billion cost of repeal is possible through means-testing and competitive bidding, experts testified before the House Energy and Commerce Health Subcommittee. Continue Reading…

Assessing Brain Death

Though published in December 2013, this article provides important information concerning the delays in determination of brain death when neurodiagnostic testing is not available. How costly is the delay? When brain injury is resistant to aggressive management and is considered fatal, a brain death protocol may be initiated to determine death according to neurological criteria. According to the study, intracranial pathophysiology leading to brain death must be considered along with clinical assessment, patterns of vital signs, and relevant diagnostic studies. Continue Reading…

Five Essential Ancillary Services for Cardiology Offices

Posted on: 01.29.15

There are dozens upon dozens of services that a cardiology office may offer. It can be overwhelming for a newly independent cardiologist to decide what technology and services to invest in first. Digirad works with thousands of cardiologists and we’ve compiled the five most essential services for any cardiologist thinking of opening his or her own office.

Basic EKG

Perhaps most essential for any cardiology office is an electrocardiogram (EKG) machine in order to test for problems with the electrical activity of a patient’s heart. EKGs are useful for evaluating the possible causes behind unexplained chest pains as well as the efficacy of medicines and medical devices, such as a pacemaker.

Stress Test

Stress tests are essential for determining the amount of stress that a patient’s heart can manage before developing either an abnormal rhythm or evidence of ischemia.

Echocardiography

Echocardiography is routinely used in the diagnosis, management, and follow-up of patients with any known or suspected heart diseases. Echocardiography can help detect cardiomyopathies, such as hypertrophic cardiomyopathy, dilated cardiomyopathy, and many others. Currently, it is one of the most widely used diagnostic tests in cardiology. Stress echocardiography is a subset of echocardiography. By utilizing stress tests during patient evaluation, stress echocardiography may help determine whether any chest pain or associated symptoms are related to heart disease by visualizing wall motion differences between stress and rest.

SPECT Myocardial Perfusion Imaging

SPECT myocardial perfusion scan (MPI) is a nuclear cardiology procedure that highlights the function of a patient’s heart muscle. MPI is useful for diagnosing a variety of heart conditions such as coronary artery disease, hypertrophic cardiomyopathy, and heart wall motion abnormalities. Images are usually acquired at both Stress and Rest allowing physicians to evaluate heart muscle perfusion to determine normalcy, ischemic, or infarcted areas.

Full Spectrum Cardiac Rhythm Event Monitoring

Cardiac rhythm event monitoring includes a variety of noninvasive tests necessary for all cardiology offices. Among the types of monitoring tests are Holter monitoring, event monitoring, and mobile telemetry, all of which involve collecting data from the patient over a period of time for suspected cardiac arrhythmias or to measure the efficacy of treatment.

Understanding the Cost Factors of Owning an In-office Nuclear Cardiology Lab

Posted on: 01.22.15

Opening your own Nuclear Cardiology lab provides you with dedicated access to SPECT Myocardial Perfusion and function studies. However, the cost to set up and maintain a Nuclear Cardiology lab can be overwhelming. Before deciding if a nuclear cardiology lab is right for your practice, it’s important to be aware of the all the associated cost factors.

Equipment

You will need to purchase a SPECT myocardial perfusion imaging system. This is typically a dual-head or triple-head nuclear gamma camera. Also, if you don’t already have one, you will need a treadmill system. Additionally, there is the cost associated with equipment repair and maintenance. This typically involves a service agreement with the manufacturer.

Hotlab

Installing and operating a hotlab requires specific equipment and supplies. At a minimum, you will need to purchase the following for your hotlab:

Dose calibrator
Geiger-Müller (GM) counter
L shield
Lead bricks
Syringe shields
Lead-lined decay bins

In addition, a Quality Control Cobalt-57 flood sheet source must be purchased annually, and a Quality Control Phantom is required for ACR accreditation.

Room

You must ensure that you have adequate space for testing and the lab. This may require the purchase or lease of additional office space, or it may be an opportunity cost associated with allocating dedicated space for the camera or lab that could be used for other patient or revenue-centered use.

Accreditation and License

There are a number of costs associated with your accreditation and license, which are required for reimbursement including:

Cost of time and resources preparing for initial Accreditation
Accreditation Application fee to IAC or ACR
Renewal Accreditation fees every three years
Radioactive Materials License (RML) initial application fee
Annual RML maintenance fee
Cost of maintaining a Radiation Safety Program, which includes ongoing quarterly meetings and documentation.

To learn more about the IAC Accreditation process, take a look at an earlier article from the Digirad blog…

Supplies

Although it is easily overlooked, don’t forget the recurring cost of supplies for your lab. This includes:

General medical supplies (IVs, syringes, leads, tubing, saline)
Radiopharmaceuticals
Pharmacological stress agents

Labor and Consultation Fees

Once you have set up your lab, you must pay for the labor to help support that lab. Labor may include:

Nuclear medicine technologist
Cardiac stress technician
Billing and reimbursement support

You may also have to compensate a nuclear cardiologist for interpretations or a radiation safety officer if you don’t already have one in house that can meet the Authorized User requirements on your radioactive materials license.

In addition to office labor, you will also need to pay for physicist consultation fees for the radioactive materials license application and the ongoing maintenance and record review for license compliance.

Support

Finally, it’s important to remember that you will need IT and infrastructure support to manage data storage and image archives. The support must also cover anything associated with HIPAA Omnibus compliance, which covers the security and privacy of protected health information.

Conclusion

After completing a cost-benefit analysis, you can determine if opening your own nuclear cardiology lab is the right choice for your practice, or if it would be more cost-efficient to use a third party mobile nuclear imaging lab.

Strategic Partnership with Perma-Fix Medical

Posted on: 01.20.15

Perma-Fix Announces That Its Subsidiary, Perma-Fix Medical, Has Entered Into a Letter of Intent as to a Planned Strategic Partnership and Investment From Digirad Corporation

ATLANTA, GA — (Marketwired) — 01/15/15 — Perma-Fix Environmental Services, Inc. (NASDAQ: PESI) today announced that its Polish subsidiary, Perma-Fix Medical, S.A. (WAR: PFM), has entered into a preliminary Letter of Intent to form a strategic partnership and secure investment from Digirad Corporation (NASDAQ: DRAD), one of the largest national providers of in-office nuclear cardiology imaging services. Digirad uses Technetium-99m (Tc-99m) in its nuclear imaging services business and provides imaging expertise to the medical community.

Under the Agreement, Digirad Corporation will invest $1 million into Perma-Fix Medical, which is a publicly traded company listed on the NewConnect market of the Warsaw Stock Exchange. The investment, when completed, would constitute approximately 5.4% of the outstanding common shares of Perma-Fix Medical. When completed, Digiradwill have the right to appoint one member to Perma-Fix Medical’s Supervisory Board, and a second appointee to either the Supervisory Board or the management team.

The investment and agreements with Digirad are subject to numerous conditions, including, but not limited to, entering into definitive supply, stock purchase and other agreements, approval by the Boards of Perma-Fix and Digirad and obtaining required approvals by Polish regulatory authorities as to issuance of the shares to Digirad.

In connection with the Agreement, Digirad will assist Perma-Fix Medical in the development of and commercialization of Perma Fix Medical’s proprietary process to produce Tc-99m without the use of uranium, as well as provide its expertise in the medical imaging business. Upon commencement of Tc-99m production, Perma-Fix Medical will supply Digirad with Tc-99m at a preferred rate.

Dr. Lou Centofanti, CEO of Perma-Fix Environmental Services, Inc., commented, “This strategic partnership and investment from Digirad, when completed, is further validation of our technology and will help accelerate development and commercialization of our proprietary process to produce Tc-99m without the use of uranium. Digirad is an ideal partner as they bring both industry and technological expertise as one of the leading users of Tc-99m, and we look forward to working closely with Matt and the rest of the Digirad team.”

Dr. Centofanti continued, “This arrangement with Digirad follows on the heels of successful testing by POLATOM in Warsaw, Poland and the Missouri University Research Reactor (MURR) in Columbia, Missouri, and the receipt of necessary approvals which allowed Perma-Fix Medical to close the previously-disclosed escrow account whereby Perma-Fix Medical was able to deliver certain shares of its previously sold stock and received out of escrow approximately $1,330,000. Looking ahead, we are focused on establishing additional strategic partners involved in the supply chain, and look forward to moving ahead with regulatory approval in the near future.”

Matt Molchan, President and CEO of Digirad Corporation, stated, “We are excited about this new partnership with Perma-Fix Medical. As one of the leading users of Tech-99m in the industry, we have a unique insight to the development process of Tc-99m. The current process for producing Tc-99m is costly and lacks a worldwide infrastructure for future development and growth, and can experience supply disruptions from time to time. We believe the Perma-Fix Medical technology solution can develop into the standard of production of Tc-99m for many years into the future and eliminate the past supply disruption issues. In addition to the economic benefits, there are numerous environmental, political and social benefits to Perma-Fix’s new process and we look forward to helping advance this technology through commercialization.”

About Tc-99m
Tc-99m is the most widely used medical isotope in the world. It allows medical practitioners to image internal body organs and is used in 80-85% of the 25 million diagnostic nuclear medical procedures each year in the U.S. alone. Common procedures include: cardiac imaging; cancer detection bone scans; gastrointestinal issues; imaging of the brain, kidney, spleen; and imaging for infections. The radioisotope market in Europe alone is expected to reach $1.6 billion in 2017, up from $1.1 billion in 2012.

Nearly all of the world’s supply of Tc-99m comes from the thermal fission of highly enriched uranium (HEU) targets in a small number of highly specialized reactors. The current process is costly and from time to time, has experienced disruptions which has resulted in short-term shortages. The current process also raises serious proliferation concerns related to the threat associated with international production, transportation and/or use of HEU in the production of medical isotopes.

Perma-Fix Medical’s technology overcomes these issues by using neutron capture to activate natural molybdenum, a common metal, to produce Mo-99, which decays into Tc-99m. Unlike conventional processes, the Perma-Fix Medical process can be produced locally using standard research and commercial reactors, thereby eliminating the need for special purpose reactors. The new process encompasses the full production cycle, from reactor to final medical supply, and should be easily deployable around the world within the current industry infrastructure.

To overcome past issues with neutron activation of molybdenum, Perma-Fix Medical has developed a specialized resin that is radiation resistant and holds large quantities of molybdenum, but at the same time releases almost 90% of the Tc-99m as it forms from the decay of Mo-99. The resin, loaded with the activated Mo-99, is placed in a technetium generator and slowly washed with a saline based solution. The eluent solution containing Tc-99m has been shown to meet targeted USP standards for pertechnetate.

About Digirad
Digirad delivers convenient, effective, and efficient diagnostic solutions on an as needed, when needed, and where needed basis. Digirad is one of the largest national providers of in-office nuclear cardiology and ultrasound imaging services, and also provides cardiac event monitoring services. These services are provided to physician practices, hospitals and imaging centers through its Diagnostic Services business. Digirad also sells medical diagnostic imaging systems, including solid-state gamma cameras, for nuclear cardiology and general nuclear medicine applications, as well as provides service on the products sold through its Diagnostic Imaging business. For more information, please visit www.digirad.com. Digirad® and Cardius® are registered trademarks of Digirad Corporation.

About Perma-Fix Medical
Perma-Fix Medical is a subsidiary of Perma-Fix Environmental Services Inc., a NASDAQ listed company. It was formed to develop, obtain FDA and other regulatory approval and commercialize a new process to produce Technetium-99, the most widely used medical isotope in the world. The new process is expected to solve worldwide shortages of Tc-99m as it is less expensive, does not require the use of government-subsidized, weapons-grade materials and can be easily deployed around the world using standard research and commercial reactors, thereby eliminating the need for special purpose reactors. Please visit Perma Fix Medical at http://www.medical-isotope.com.

About Perma-Fix Environmental Services
Perma-Fix Environmental Services, Inc. is a nuclear services company and leading provider of nuclear and mixed waste management services. The Company’s nuclear waste services include management and treatment of radioactive and mixed waste for hospitals, research labs and institutions, federal agencies, including the DOE, the Department of Defense (“DOD”), and the commercial nuclear industry. The Company’s nuclear services group provides project management, waste management, environmental restoration, decontamination and decommissioning, new build construction, and radiological protection, safety and industrial hygiene capability to our clients. The Company operates four nuclear waste treatment facilities and provides nuclear services at DOE, DOD, and commercial facilities nationwide. Please visit Perma Fix Environmental Service at http://www.perma-fix.com.

This press release contains “forward-looking statements” which are based largely on the Company’s expectations and are subject to various business risks and uncertainties, certain of which are beyond the Company’s control. Forward-looking statements generally are identifiable by use of the words such as “believe”, “expects”, “intends”, “anticipate”, “plans to”, “estimates”, “projects”, and similar expressions including, but not limited to, completion of agreements between Digirad and Perma-Fix Medical, validation of our technology, development and commercialization of the Tc-99 process and the benefits of such process. These risks are detailed in Perma-Fix Environmental Services and Digirad’s filings with the U.S. Securities and Exchange Commission, including the Annual Report on Form 10-K, Quarterly Reports on Form 10-Q, Current Reports on Form 8-K and other reports. Readers are cautioned to not place undue reliance on these forward-looking statements, which speak only as of the date hereof. All forward-looking statements are qualified in their entirety by this cautionary statement, and each company undertakes no obligation to revise or update the forward-looking statements contained herein.

Contacts:

For Perma-Fix Environmental Services and Perma Fix Medical
David K. Waldman-US Investor Relations
Crescendo Communications, LLC
(212) 671-1021

Herbert Strauss-European Investor Relations
herbert@eu-ir.com
+43 316 296 316

For Digirad Corporation
Jeffry Keyes
Chief Financial Officer
(858) 726-1600
ir@digirad.com

January News Digest

Posted on: 01.15.15

The imaging industry is continually evolving and it’s important to stay informed about the changes that may impact the development, operation, maintenance, and growth of your imaging services.

ASNC Introduces New Self-Assessment Program

The American Society of Nuclear Cardiology is releasing a new Nuclear Cardiology Knowledge Self-Assessment Program (NCKSAP) designed for practitioners performing nuclear imaging studies and preparing for certification or recertification in nuclear cardiology. The program will be comprised of eight modules. The first five modules are available for purchase online now. Each module will have a total of 30 multiple-choice questions, rationales, and references designed to help users assess their nuclear cardiology knowledge. Continue Reading…

ASNC Continues Advocacy Work

The American Society of Nuclear Cardiology has released a report detailing its continued advocacy efforts on behalf of its members and the field of nuclear cardiology. Among other efforts, ASNC advocated for changes to the United Healthcare Cardiac Prior Approval Process. ASNC also worked with United Healthcare to halt for reconsideration a policy to track provider performance based only on utilization and not on appropriate use of imaging services. Continue Reading…

Study Finds Few with Diabetes Have CAD Events with Normal Heart Imaging

A new report published in the October issue of JACC: Cardiovascular Imaging has found that high-risk asymptomatic patients with diabetes mellitus and normal myocardial perfusion single-photon emission computed tomography have a low rate of first manifestations of coronary artery disease. However, the report also found that patients with DM and abnormal MPS have a seven-fold higher rate of progression to overt or silent CAD despite therapy. Continue Reading…

ASNC Debuts New Online Webinar

In December, the American Society of Nuclear Cardiology released a new online webinar discussing the best practices in the nuclear cardiology field. According to ASNC, the free webinar is designed to increase cardiologists’, radiologists’, and nuclear medicine physicians’ knowledge on the “Practical Approach to Patient-Centered Imaging.” Users may access an archived version of the webinar on the ASNC’s website. Continue Reading…

CMS Updates Physician Fee Schedule Online Search

The Centers for Medicare and Medicaid Services updated its website to increase the functionality of its online physician fee schedule search. The site allows users to search pricing amounts, various payment policy indicators, RVUs, and GPCIs by a single procedure code, a range, or a list of procedure codes. Users may also search for the national payment amount and a specific Carrier/Medicare Administrative Contractor or locality. Continue Reading…

Imaging with Ergo™ in the ICU

Posted on: 01.07.15

digirad-ergo-icu The Ergo™ Imaging System is a multi-purpose solid-state large field of view nuclear gamma camera that is ideal for use in the ICU. It is completely portable, which allows for point-of-care diagnostic imaging.

In the past, portable cameras had a reputation of being bulky and loud with a limited field of view. The Ergo revolutionizes the portable camera using solid-state flat panel detector technology. Since the Ergo does not use Photo-Multiplier tubes in its detector, it is quiet, compact, light, and easy to maneuver. Built for general purpose planar, dynamic, and gated imaging, the Ergo is ideal for Brain Flow, GI bleed, V/Q lung, Gastric Emptying, Gallbladder and MUGA studies, just to name a few.

The benefits of imaging in the ICU with the Ergo include:

Reduced risk of patient infection

By keeping patients in the ICU and bringing the camera to them, patients may have a reduced risk of infection or other complications that could arise during the transportation process. Transportation from the ICU to the imaging department and back can put strain on the patient, which creates more risk to their stability. Point-of-care imaging with the Ergo™ helps to reduce patient exposure to these potential risks.

Less trauma for patients and their families

Being admitted to the ICU is already a stressful event for patients and their families. Moving a patient out of the ICU for imaging can add further stress to the situation. ICU patients require special attention. Traumatic events, such as the need for a brain-death scan, can be handled much easier and with greater discretion and compassion utilizing the Ergo at the patient’s bedside.

Optimizing hospital staff

The Ergo’s portability also allows for staff optimization and higher quality patient care. Point-of-care imaging with the Ergo keeps ICU staff “on the floor” and attending to all ICU patients rather than having to send valued staffers such as critical care nurses and respiratory therapists to the imaging department for an extended period of time. Imaging in the ICU is performed with the patient remaining in their own bed. This alleviates the need for lifting patients, reducing the risk of strain and injury to both the patient and staff.

The Ergo provides security and benefits for all involved in the ICU and imaging process, from the patients to their families and the hospital staff.

Top 6 Hurdles of IAC Accreditation/Reaccreditation

Posted on: 12.23.14

Maintaining your practice’s accreditation with the Intersocietal Accreditation Commission (IAC) can be a daunting task to take on alone. The IAC imparts certain requirements for practices to meet in order to maintain their accreditation. These requirements are in place to ensure that practices are continuing quality care, and held to industry standards. Knowing what challenges to expect can be a helpful tool when preparing for a successful accreditation process.

CME and CEU Credits

To maintain accreditation, physicians are required to complete a minimum number of relevant, continuing medical education (CME) credits, while technologists are required to complete a minimum number of relevant, continuing education units (CEUs). Physicians and technologists are required to complete 15 credits within the three-year accreditation period that must comply with IAC standards and be completed within a relevant field related to their accreditation.

Often, physicians and technologists are not aware of which courses are considered relevant. The individual(s) in charge of completing your practice’s accreditation/reaccreditation is crucial to this phase of compliance, as they can guide physicians and technologists toward the appropriate courses. Understanding the continuing education requirements early on in the accreditation period is crucial to ensure that all physicians and technologists have enough time to complete the appropriate courses.

Report and Case Study Compliance

Report and case study compliance is another potential challenge to the reaccreditation process. It is vital to the approval process that the reports comply with IAC standards. Ensuring that experienced and knowledgeable staff review reports prior to submission will help minimize delays due to non-compliance. Report compliance includes specific parameters for study protocols, defect analysis, case study image formats, and proper report completion times.

Organizational Changes

A seasoned employee with accreditation experience is an asset during the reaccreditation process, and if that staff member is no longer with the practice, reaccreditation becomes a new, complicated task. The new employee must learn the accreditation process and complete and deliver the appropriate materials after correctly preparing them. There is more room for error with an inexperienced preparer than one who has worked with the accreditation process for your practice before.

Additionally, it is considered a best practice to update the IAC with any changes to your staff, equipment, or protocols, and if the notification was overlooked, there will be issues when your practice pursues its reaccreditation. The notification period for a change in technologists is within the year of the change, but changes to positions like Medical Director have a notification period of 30 days.

Updated Policies and Procedures

Physicians must also ensure that their practice policies and procedures are updated and current upon reaccreditation submission. Time plays a part in this challenge as well because these updates should be completed throughout the three-year period as the changes arise. Often, this section of the reaccreditation requirements is not met and may cause a delay in accreditation/reaccreditation due to non compliant protocols or inconsistency with reports.

Quality Improvement Plan

As part of the reaccreditation process, your practice must submit a Quality Improvement Plan. This plan shows that your practice is dedicated to providing high quality imaging services. Part of this endeavor is holding regular quality improvement meetings, along with documenting meeting minutes. This QI process is often documented but not implemented. It is important to have staff that understand the parameters to this QI plan and commit to following the necessary requirements to ensure IAC compliance.

Time Commitment

Achieving and maintaining your accreditation is a time-consuming task. The most effective way to assure that the reaccreditation process is completed without complication is to ensure that all the required materials are gathered and organized well in advance.

One Solution

Outsourcing the accreditation process is a helpful way to ensure that all aspects of the process are anticipated and completed. Regardless of the modality, Digirad offers its customers an accreditation service to provide practices with certified, accredited professionals to make the process of achieving and maintaining IAC or ACR accreditation smoother.

Advances in Mobile Cardiac Outpatient Telemetry

Posted on: 12.18.14

Mobile cardiac outpatient telemetry (MCOT or MCT) is an innovative technology that cardiologists use to monitor patients’ every day cardiac behavior. The technology that powers MCT is continually evolving and below are a few of the latest innovations we are seeing emerge.

One-Piece Devices

Traditional MCT systems have been two-piece systems that contain a receiver and a transmitter. The two-piece equipment contains wires that are attached to leads, which close the circuit from the heart to the receiver to the transmitter. Recent developments in MCT technology have created a one-piece device that can store data for up to thirty days. The one-piece device features a single receiver/recorder. One-piece designs are appealing to patients because they only have to worry about one piece of equipment, and it is less obtrusive.

Extended Holter Technology (Patch)

Extended Holter, or “patch” technology as it’s commonly known, is a “long term” Holter device and not MCT technology. Though the “patch” does not require wires, it is a two piece technology that requires data to sync to a remote device via Bluetooth technology. Though this “Band-Aid” Style Patch adheres directly to the patient’s chest without wires, it is fairly large at roughly 5 inches long, 2 inches wide and more than an inch thick.

GPS and Accelerometers

MCT devices are now integrating GPS technology and accelerometer metrics. These additional measurements enhance the data that the MCT transmits to the cardiologist, which then enhances diagnostic abilities. The GPS feature allows the physician to gather geographic data about where the patient was during different points in the data. The accelerometer provides a picture of the activity that the patient was engaging in at the time of an event. These features provide a broader scope and more detailed evidence that can help cardiologists understand the status of their patients’ heart function.

The bottom line…

Advancements that are easier to use, produce broader data spans and encourage patient compliance are all positive developments but must be tested. As a leader in the heart monitoring space, Telerhythmics is constantly testing and evaluating these technologies. This evaluation will help us determine which devices will be the most stable and beneficial for customers. It’s also important to remember that technology is only one piece of the equation. Ultimately, the most successful heart monitoring programs are those with the Cardiac Trained RNs using customized QA reports.

Will It Fit? Space Requirements for Digirad Cameras

Posted on: 12.11.14

Solid-state cameras from Digirad are smaller, lighter, and more compact than what you typically find with other nuclear gamma cameras. Our Ergo, Cardius^® 2XPO, Cardius^® 3XPO and Cardius^®X-ACT imaging systems are conveniently sized, and can fit into standard-sized exam rooms and door frames without special modifications. So the short answer is “yes, it will fit.”

Minimum room sizes for Digirad cameras:

Cardius 2XPO
Minimum room size: 8’ x 7’

Cardius 3XPO
Minimum room size: 8’ x 7’

X-ACT
Minimum room size: 8’ x 9’

Ergo
Minimum room size: 8’ x 8’

Space considerations for private practice clinics

Both the Cardius 2XPO and Cardius 3XPO cameras provide patients with an open design and a compact frame that is easy for technologists to operate. These cameras are ideal for cardiology offices because the solid-state flat-panel detector technology and geometry allow for high image quality with optimal throughput. Both of these systems are small enough to fit in a standard exam room, and the Cardius 2XPO is available in either fixed or mobile configurations.

Space considerations for hospitals

The X-ACT and Ergo cameras are ideal for any hospital setting.

The X-ACT camera fits in an 8×9 room, and it does not require shielding or special room requirements. With its triple-head capabilities, the X-ACT is patient-centric, reducing the radiation dosage to the patient by up to three times that of other conventional nuclear cameras. The X-ACT camera also provides physicians with attenuation correction to improve diagnostic imaging confidence.

The Ergo is a flexible, multi-purpose nuclear imaging camera. Because of its size and portability, the Ergo can be brought to the patient’s room and to various departments including the ICU, pediatrics, women’s health, or surgery. This eliminates the need for transporting a patient and reduces the need for additional hospital staff.

Contact our team if you have any specific questions about the size or use of a Digirad Solid-State nuclear camera in your facility.

Anger v. Solid-State Imaging – It’s Time To Upgrade

Posted on: 11.25.14

Nuclear medical imaging technology has evolved drastically over the years; however there are surprisingly still a large number of antiquated Anger-based imaging systems in use today. These Anger technology gamma cameras use vacuum tube photomultipliers (PMTs) and hygroscopic sodium iodide (NaI) crystals, technologies that are now more than 50 years old.

Digirad developed a solution to the limitations of the Anger camera with the creation and design of solid-state nuclear imaging systems. Solid-state cameras offer a number of benefits over Anger-based systems including, but not limited to, their ultra compact and lightweight design, higher quality images, enhanced patient experience, and their ability to be used in fixed or mobile configurations.

Image Quality

Digirad’s solid-state pixilated Cesium Iodide detectors provide high performance over the entire useable field-of-view. With Anger technology, the performance degrades as you move away from the center of the detector. Solid-state pixilated detectors take out the guess work in image processing by providing the precise location of the gamma ray emitted, where Anger-based PMTs require estimation on where the location of the gamma is that hits the Nal crystal. In addition, solid-state image contrast is superb.

Compact Design and Cost Benefits

Digirad’s Cardius® series cardiac SPECT cameras require only 7 x 8 feet of space (a typical exam room) due to their open upright design and small footprint. Digirad’s Ergo™ is portable and can be moved wherever needed throughout the hospital. Digirad cameras don’t need to be anchored to the floor and require no special floor preparations as typical with Anger type cameras. Digirad’s solid-state camera systems weigh less than 800 pounds making installation possible on nearly any floor, typically without any room modifications. Installation is generally two days or less compared to one to two weeks for most Anger cameras, not to mention the time and cost associated with any construction requirements to accommodate the larger Anger systems. Also, Digirad’s cameras can be easily and inexpensively relocated at any time.

Enhanced Patient Care

Solid-state benefits enhance the quality of care that physicians can provide to patients in more ways than one. With Digirad’s Ergo™ portable imaging system in the hospital, patients who are in critical condition or who have mobility restrictions can have this technology brought right to them.

Claustrophobia is reduced or eliminated with the open design on all Digirad cameras. With Digirad’s Cardius® systems, patient comfort is improved considerably with the upright design and patient chair where patients can sit comfortably, rather than lying down. The compactness of solid-state detectors means the patients’ arms don’t have to be raised as high as traditionally required using larger Anger-type detectors. Digirad’s revolutionary solid-state technology also paved the way for use of the Cardius systems in Digirad’s mobile nuclear cardiology services solution.

Solid-state technology is revolutionizing the way that physicians perform nuclear diagnostic imaging. By enhancing the quality, decreasing the footprint, and improving the patient experience, Digirad’s solid-state technology is providing new dimensions to nuclear imaging.

November News Digest

Posted on: 11.20.14

The imaging industry is continually evolving and it’s important to stay informed about the changes that may impact the development, operation, maintenance, and growth of your imaging services.

Moly 99 reactor could lead to U.S. supply of isotope to track disease

An Albuquerque startup company has licensed a Sandia National Laboratories technology that offers a way to make molybdenum-99, a key radioactive isotope needed for diagnostic imaging in nuclear medicine, in the United States. Known as moly 99, it is made in aging nuclear reactors outside the country, and concerns about future shortages have been in the news for years. Continue Reading…

SNMMI SmartBrief Special Report: Patient-centered care in cardiology

Patient-centered care gets a lot of attention today amid increased focus on cost, quality, and satisfaction in health care. But in the nuclear medicine and molecular imaging specialty, where imaging zeroes in on how a patient’s body is functioning at the molecular level, personalization and a patient-centered approach are nothing new. Imaging societies were early adopters of Choosing Wisely, radiation safety measures and other means of continually boosting the quality of care. This special report from SNMMI SmartBrief highlights best practices for care — and for your practice — as these topics shape conversations about medicine, reimbursement, and the delivery of care. Continue Reading…

Data mining has huge potential to affect care of patients

Medical researchers are using Big Data to learn more about the effects of drugs, and their work is creating the prospect of a “learning health system,” Veronique Greenwood writes. A doctor who used medical records to show that a patient might need anti-clotting drugs said the feeling used to be that research being done now will help patients in future years, but soon it could be common for research to help patients immediately. Continue Reading…

What puts the most pressure on hospitals? 6 top factors

Pressure on hospitals is shifting from simple cost-cutting issues to increased attention on healthcare reform initiatives focused on value and outcomes, according to Ernst & Young’s 2014 report, “Pulse of the industry: Differentiating differently.” Continue Reading…

2014 RSNA 100th Scientific Assembly and Annual Meeting

Posted on: 11.13.14

Come see our Ergo™ Imaging System at Booth 6733

The Radiological Society of North America (RSNA) is hosting its 100^th Scientific Assembly and Annual Meeting in Chicago, Illinois from November 30 to December 5 this year at McCormick Place. Digirad will be exhibiting the Ergo in collaboration with Dilon Technologies as part of the almost 700 other exhibitors who will be showcasing their technologies.

The RSNA will be hosting the Canadian Association of Radiologists and the Korean Society of Radiology at this year’s event. The annual meeting welcomes experienced professionals who are well-versed in a variety of specialties to share their research and expertise with attendees. Featured sessions of the RSNA meeting include the Image Interpretation Session, Cases of the Day, Mock Trial, and the unique RSNA Diagnosis Live. This session is approved for AMA PRA Category 1 Credit.

We are excited to be pairing with Dilon Technologies, who specializes in molecular imaging, to present the Ergo and discuss its convenient, portable, solid-state capabilities. We welcome you to visit booth 6733 to experience the latest technology available in imaging for general nuclear medicine, women’s health, pediatrics, and critical-care patients.

10 Myths about Mobile Imaging – Part 2

Posted on: 11.05.14

Mobile imaging service is a cost, time, and resource-effective alternative to owning and operating your own Nuclear Cardiology lab, but there are understandably a number of questions around the service. Will I get paid? Are the images any good? Are the technicians qualified? These are good questions and we want to take a moment to address 10 of the most common myths we hear. Here is part two:

6. Mobile imaging is disruptive to my office
When Digirad deploys our employees to your practice, they recognize that they are invited into your practice. They proceed with their tasks seamlessly and without disrupting your office. Digirad employees are involved in all aspects of imaging procedures to assist your office staff, including post-screening and discharge procedures. Our highly trained employees integrate themselves with your practice and procedures to become an asset and contribute to the overall success of your business.

7. Mobile imaging space requirements are problematic for my office
Digirad mobile imaging can provide creative solutions for practices with little extra space and small exam rooms. With a footprint about the size of a desk, our cameras can be maneuvered into almost any exam space to perform the necessary imaging. If necessary, our dedicated employees may rearrange exam rooms to fit the camera, and when the procedure is over, they restore the exam room to its original layout. The added advantage is that this space is available for you to provide other services to your patients on days you are not performing imaging.

8. Mobile imaging cameras are not able to perform all the cardiac imaging studies that a stationary camera can
Digirad’s mobile imaging cameras have the capability to perform Nuclear Cardiology studies, including MUGA studies and Stress/Rest SPECT.

9. My practice is too busy to worry about pre-certifications and other requirements necessary to bill and collect
Digirad offers busy practices a service that performs pre-certifications. The practice provides access to the basic information and our team can complete the necessary forms to obtain authorizations. In addition, our Reimbursement Support team can assist you with any billing questions or concerns.

10. Using a mobile imaging vendor does not allow me to have control over the personnel and imaging process
Your office oversees Digirad’s mobile imaging equipment and staff, which means that the lead physician supervises Digirad staff. Your practice can maintain complete autonomy and control while using our experienced staff to assist with in-house imaging services. Additionally, our service provides you with more oversight than sending your patients to a hospital or imaging center.

10 Myths about Mobile Imaging – Part 1

Posted on: 10.30.14

Mobile imaging service is a cost, time, and resource-effective alternative to owning and operating your own Nuclear Cardiology lab, but there are understandably a number of questions around the service. Will I get paid? Are the images any good? Is the staff qualified? These are good questions and we want to take a moment to address 10 of the most common myths we hear.

1. Portable or Mobile imaging cameras do not provide the same quality images or accuracy as a fixed imaging camera.
Digirad’s mobile imaging cameras use digital solid-state circuitry that is more advanced than most other fixed or stationary cameras in the market. Our platform is high quality, stable, and reliable, so we can convert our technology into a mobile, portable format. Digirad’s mobile imaging cameras are dependable and used in luminary institutions. The images that mobile cameras produce are of equal or often better quality to, and as diagnostically accurate as, the images produced by stationary or fixed camera systems.

2. Mobile camera operators are not as well-trained or committed to providing accurate, quality images.
Digirad employs highly skilled personnel with specific imaging and personality skill sets. These highly technical professionals also undergo a thorough screening process prior to being hired. Upon starting with Digirad, all technologists undergo extensive training on our systems, on our processes, and on customer service. They also benefit from our continuous improvement processes, ongoing education, and evaluations. This ensures that our employees are held to higher quality standards which include customer and patient satisfaction requirements. Digirad also offers our employees quarterly incentives that are issued for outstanding performance.

3. Mobile imaging is not allowed under Medicare.
Many physicians are concerned that mobile imaging is not regulatory-compliant and accepted under Medicare because it is not performed at a hospital. However, Digirad’s service is regulatory compliant under Medicare, and further, we are accredited by and through the Intersocietal Accreditation Commission. Our services and models are independently audited to ensure federal and state compliance.

4. Insurance companies will not pay for, or pay less for, mobile imaging.
The vast majority of insurance companies do not have a preference for mobile or stationary cameras. Insurance companies provide reimbursement based on accreditation. Through our Diagnostic Services, our clients are fully accredited by IAC which is recognized by CMS and by private payers. Digirad clients also have access to national reimbursement consultants at no additional charge. Our Diagnostic Services provide solutions for the various challenges that physicians, healthcare systems, and hospitals face.

5. Mobile imaging is too expensive, and my practice will lose money.
This is simply not true. Mobile imaging is a very cost efficient approach to providing SPECT myocardial perfusion imaging (MPI) for your patients. When you own a Nuclear Cardiology Lab, the biggest financial challenge is that your fixed costs (equipment, repair & maintenance, licensing, physics consultation, accreditation fees, accreditation consultation, etc.) per study can continue to increase. With our As Need, When Needed, Where Needed approach, that is never an issue. Using our mobile services allows your practice to pay-as-you-go with a known cost basis that results in known profitability to provide these services for your patients. Without the fixed overhead cost, Digirad mobile imaging is a very cost efficient choice for practices who desire high-quality imaging services at a lower price.

Understanding Nuclear Imaging Accreditation

Posted on: 10.23.14

Many practices have questions about the process and cost of accreditation and reimbursement for imaging before offering nuclear imaging services. As a manufacturer of nuclear cameras, and a provider of diagnostic services, Digirad has a deep understanding of the accreditation process. Below are the answers to some of the most commonly asked questions about nuclear imaging accreditation.

Do I need to be accredited to be reimbursed?
Yes. Practices that offer advanced imaging services, including nuclear imaging, are required to be accredited to receive reimbursement.

How long does the accreditation process take?
The typical accreditation process is completed in an average of 3 to 6 months. Applying for accreditation requires a variety of tasks, including purchasing the camera, hiring qualified staff, and establishing the proper procedures and protocols.

Digirad is accredited by the Intersocietal Accreditation Commission (IAC). When practices use Digirad’s nuclear imaging accreditation services, the accreditation process is completed in 1 to 2 months. During that time, practices are covered by Digirad’s provisional accreditation umbrella. This umbrella accreditation allows practices to immediately begin billing for their imaging services and to become eligible for reimbursement.

Can I use a consultant, and what are the fees associated with a consultant?
Using a consultant can be a costly option. The base application fees for accreditation can cost up to $3,300. Many practices seeking accreditation on their own will need a consultant to assist with the process. Consultant fees can range from $10,000 to $15,000. Digirad’s tiered pricing approach to accreditation reduces these fees by more than half of the cost to apply independently.

How do I get started?
Digirad brings more than ten years of accreditation service experience to our clients. We handle the application process for the practice site location and reading physicians, and while the practice’s accreditation is pending, Digirad’s provisional accreditation covers the practice.

Digirad also provides our clients with Reimbursement Support as a supplemental service. This ensures that any issues encountered during the accreditation process are addressed.

Digirad’s nuclear imaging accreditation services also provide practices with the appropriate equipment and knowledgeable staff so that your practice’s nuclear imaging can be successful for your patients and your business.

How long does it last?
Accreditation lasts 3 years. However, your practice is required to maintain accreditation during this time, and quarterly quality assurance meetings are arranged to review the program. This allows your practice and Digirad to work together to take steps to improve any necessary areas. The accrediting association performs at least 1 audit per 3-year period to maintain the highest level of service, so keep in mind that maintaining accreditation is an ongoing effort.

October News Digest

Posted on: 10.01.14

The imaging industry and healthcare in general is continually evolving. It’s important to stay informed about the changes in healthcare that may impact the development, operation, maintenance, and growth of your imaging services. Here is a look at some recent news articles.

2015 Proposed HOPPS/ MPFS Payment Charts

On July 3rd, 2014, the Center for Medicare & Medicaid Services released the proposed payment rates on CY2015 for services furnished under the Hospital Outpatient Prospective Payment System (HOPPS) and the Physician Fee Schedule (PFS). Below are two charts that capture proposed RVUs for pertinent codes for CY2015. Continue Reading…

ASNC Choosing Wisely Video Series

The American Society of Nuclear Cardiology, in partnership with the ABIM Foundation has launched a video series on their YouTube channel as a part of the “Choosing Wisely” campaign. The video series helps you to identify which patients should, or should not be, imaged based on their clinical characteristics. Click play to take a look…

CXO: Making patient experience a C-suite priority

The pile of letters complaining about a parking attendant was the tipping point for Kristine K. S. White, RN, MBA. White, in an exchange that would prepare her for the role of chief experience officer, confronted the surly staffer in his booth. He was, after all, often patients’ first encounter with Spectrum Health in Grand Rapids, Michigan. He acknowledged that he had heard about patients’ displeasure but what was he supposed do? Continue Reading…

Studies Explore CV Impacts of Wine, Coffee and Energy Drinks

From coffee increasing the risk of pre-diabetes in young adults with hypertension, to wine only protecting against cardiovascular disease in people who exercise, to the heart risks associated with energy drinks, several studies presented at ESC Congress 2014 provide new information about the impacts of some of these more popular beverages on cardiovascular health. Continue Reading…

Three mistakes to avoid when choosing a heart monitoring provider

Posted on: 09.25.14

Heart monitoring is increasingly a service that physicians are offering as part of their standard of care. Advances in mobile cardiac telemetry (MCT) monitoring are making it easier to provide heart monitoring services, and these advances are making the service more effective for patients experiencing heart related issues. With the growth in the market, physicians are seeing an increasing number of providers in the heart monitoring space. So how do you pick the right provider? We’ve put together a few tips on what to look for.

Mistake 1: Getting locked into a single technology or manufacturer
It’s best to find a heart monitoring provider that takes a “device agnostic” approach to recommending technology. A firm or manufacturer with vested interest in a specific device might not give you the full picture of what’s happening in the market. Holter monitoring, 30-day cardiac event tracking, and mobile cardiac telemetry (MCT) are the three largest types of heart monitoring services. It’s important to know that there are many options under each of those three categories. Find a provider that will recommend the method and technology that is right for you and your patients – not the provider’s bottom line.

Mistake 2: Not finding out who is monitoring the data
Technology is great, and there have certainly been advancements in how data is collected. Data collection is important, but what happens with that data is even more critical. Before choosing a provider, you need to know who is monitoring the data. Do the providers you are evaluating employ Cardiac Trained Registered Nurses (RNs)? Do their RNs monitor all tests for quality assurance, or do they only provide periodic spot checks? In general, experienced cardiac trained RNs maintain a higher level of expertise than Certified Cardiographic Technicians (CCT), will produce higher quality assurance and reporting, and offer the most effective level of service. Find out who is reading your data before selecting a partner.

Mistake 3: Choosing a provider with poor reporting capabilities
What can the providers you choose do with the data they collect? Setting up a monitoring device may be easy but you’ll be dealing with the reports they provide much more frequently. A few critical questions to ask are:

Does the reporting allow for customization?
How promptly are the reports delivered?
Who creates the reports (software or a trained RN)?
What flexibility is there in terms of report delivery (encrypted email, fax, web, HL7 interface)?

If you are currently looking for a provider or are curious about these services, we encourage you to do your research and due diligence to avoid these mistakes. We also recommend taking a look at Telerhythmics. Their team is committed to providing an excellent experience for both physicians and patients. Learn more at their site >

Customer Profile: Micah Eimer, MD, FACC

Posted on: 09.17.14

Digirad recently had the opportunity to speak with Micah Eimer, MD, FACC, a cardiologist in Glenview, IL. Here’s what he has to say about the nuclear cardiology services from Digirad.

Tell us a little bit about what you do and what led you to Digirad.

I had been in private practice for seven years when I was contacted about starting a new cardiology division in the suburbs. We were starting with a blank slate, and one of the major components was nuclear cardiology testing. Because the division was new, and it was unclear what the volume would be, we were hesitant to invest heavily in equipment and staff. The Diagnostic Services offering from Digirad was a great fit that allowed us to get up and running without purchasing the equipment or hiring a dedicated staff.

What type of services does the Digirad team provide?

We use the nuclear cardiology services and are frequently performing myocardial perfusion studies. The team from Digirad comes to our facility one day a week and typically performs 5-7 studies per day. They arrive with the camera, staff and handle all the imaging.

Did you have any questions or reservations before signing up?

Honestly, yes. Sitting up is not historically how nuclear studies are done, and the footprint of the Digirad camera is very small. So I did have some initial concerns but the image quality has been superb.

How has the service worked out?

The services from Digirad have worked out beautifully. We can request the exact amount of equipment and staff that we need. The team does an expert job of getting their work done. At the end of the day they leave, and you don’t even know they were there.

What about the Digirad staff? How do they work with your patients and your full-time staff?

The staff from Digirad has been wonderful. It’s more or less the same people every week, and they handle the patients very well. Patients uniformly tell us they had a good experience. They are very autonomous and do not require a lot from our staff.

What type of financial projection or models did you use to make the “buy vs. rent” decision?

It was a pretty easy decision. Because the department was essentially a start-up, we knew the volume would be low. So purchasing new equipment was not an ideal option. Plus, we had to factor-in the time commitment to run the lab. It’s more than the expense of the camera that must be taken into account. Things like certification, the inspections, spills, the hot lab, etc. all have to be considered. One of the reasons you leave private practice is to not worry about this stuff anymore. With Digirad, it’s a much more pleasant and personally satisfying.

What is ICD-10?

Posted on: 09.11.14

ICD stands for International Classification of Diseases and is a set of codes used by medical providers to standardize the way a diagnosis is recorded. The current version is ICD-9 with the “9” indicating that it is the 9th edition.

ICD-10 is the 10th edition, and the change was necessary for a number of reasons. ICD-9 limited the amount and types of data that could be collected, is over 30 years old, and the number of codes that can be created is at its limit.

There are two types of ICD-10 codes: ICD-10-CM for diagnosis coding and ICD-10-PCS for inpatient procedure coding. The new version will accommodate close to 69,000 codes and allows for the notation of new diagnoses.

What’s Next for ICD-10

This past April, the compliance date for ICD-10 was pushed from October 1, 2014 to October 1, 2015. Billing and reimbursements are a critical concern for providers, and the nature of the delay has caused uncertainty and confusion for many practices.

After years of delays, it now appears that the October 2015 date is indeed the true launch date. While larger health systems have had the capital to invest in the conversion, many smaller practices are still struggling with when and how to approach the change. ICD-10 is a more complex system and will require more training and expertise to ensure reimbursements are coded properly.

For the time being, practices are being forced to run both systems and gradually gain experience with ICD-10 ahead of the permanent change.

What caused the delay?

On April 1st, the Protecting Access to Medicare Act of 2014 (PAMA) (Pub. L. No. 113-93) was enacted, mandating the Secretary of Health and Human Services not adopt ICD-10 prior to October 1st 2015.

The previous implementation date of ICD-10 was October 1, 2014 but after pressure from groups like the AMA, congress decided to delay the start date until October 1, 2015. The concept behind the delay was to give practices more time to prepare, and pay for, the costs associated with the change. While the extra time is helpful, the uncertainty surrounding the deadline is not, and many practices are struggling to know when to make the change.

What does the delay mean for your practice?

The latest change requires HIPAA covered entities to continue to use ICD-9-CM through September 30th, 2015. Many third-party payers have already posted ICD-10 codes in coverage policies to take effect October 1st of this year and are in the process of changing policies to have both ICD-9 and ICD-10 until September 30th, 2015.

Strategies for Meeting the 2014 ASNC Imaging Guidelines

Posted on: 08.27.14

Changes to patient radiation exposure levels are just around the corner. In 2010, the American Society of Nuclear Cardiology (ASNC) issued a goal with a deadline of 2014. The nuclear imaging community is challenged to significantly lower radiation exposure in SPECT myocardial perfusion imaging without sacrificing quality before the end of this year.

The ASNC recommends three combined approaches to lowering radiation exposure:

Appropriate selection of patients
Creation of protocols that lessen total radiation exposure
Use of equipment and processing methods that achieve the best image quality at the lowest possible radiation dose

Click here for more information on these guidelines, including examples of techniques, read the Intersocietal Accreditation Commission (IAC) article.

How Digirad Can Help

The new guidelines place considerable emphasis on advancing technology through either modification of existing imaging systems or purchase of new equipment. Does your current nuclear imaging equipment allow you to produce high quality images and significantly lower the radiation exposure to your patients?

Digirad is uniquely positioned to help you meet or exceed the ASNC Guidelines with its cutting-edge software, cameras, and diagnostic services programs. As a standard feature, Digirad utilizes High Definition Solid-State detectors which increase count sensitivity and allow you to reduce the injected dose to your patient. In addition, the following software and hardware elements lower patient exposure to radiation and enhance the imaging process.

nSpeed

nSPEED™ is Digirad’s 3D OSEM advanced reconstructive software. It provides superior image quality and reduces acquisition time or patient dose by half compared to standard filtered back projection reconstruction techniques. Most users lower both the patient dose and the scan time to create an optimized protocol that is both faster and lower dose. If desired, you could cut your injected doses in half and still obtain high quality images within normal scan times. The software enables depth-dependent resolution recovery and improved chamber contrast, resulting in better SPECT image resolution. nSPEED is optimized for use with all Digirad cardiac solid-state detector systems.

Triple-Head Camera

Use a triple-head camera in place of a dual-head camera to speed up image acquisition. Both the Cardius® 3 XPO and the Cardius® X-ACT offer a third detector to improve efficiency by 38%. Improved efficiency means faster imaging and smaller dosage for patients of all sizes. A Digirad triple-head camera would allow you the option of injecting about 35% of the typical dose or scanning for 35% of the typical time. Most users cut both dose and scan time. You’ll meet the ASNC Guidelines while improving workflow and patient comfort.

The Cardius® X-ACT combines triple-head hardware with Fluorescence Attenuation Correction for the lowest possible dose and highest quality images of any standard nuclear camera. The advanced features of this compact system offer all of the benefits of the Digirad triple-head camera and add the clinical confidence only found with low dose Attenuation Correction. Lower dose, faster scan, higher clinical confidence.

Diagnostic Services

All Digirad Systems within the Diagnostic Services division are equipped with HD Solid State Detectors and nSPEED™ advanced reconstruction software. Practices and hospitals utilizing Digirad’s Diagnostic Services have been using the tools to meet or exceed the new ASNC standards for dose reduction for the last few years.

Whether you are interested in upgrading your technology through purchase or through signing on as a Diagnostic Services customer, achieving and outperforming the new ASNC reduced radiation dose standards is simple with Digirad’s innovative technology and services.

ASNC Annual Meeting

Posted on: 08.21.14

Visit us at Booth 216!

This fall, the American Society of Nuclear Cardiology will host its 19th Annual Scientific Section. This renowned four-day event gathers specialized physicians, scientists, technologists, nurses, and many others from around the world. The conference will be held September 18-21, 2014, at the Seaport World Trade Center in Boston, MA.

ASNC 2014 offers opportunities to meet with leading decision-makers in nuclear cardiology and cardiovascular CT, learn from unparalleled educators, and renew your commitment to the profession with various career enhancement opportunities. Alongside lectures, ethics workshops, panel discussions, and presentations on leading research in the field, you will find an exhibition room packed with the latest and finest technology and services.

Digirad is pleased to announce it will be showcasing the Cardius® X-ACT dedicated cardiac SPECT imaging system with Attenuation Correction and our Administrative Services designed to maximize the quality, efficiency and profitability of your Nuclear Cardiology lab. Visit us at Booth 216 in the center of the exhibition hall! For more information, go to the ASNC website: http://www.asnc.org/asnc2014/index.cfm.

We hope you’ll stop by and say hello!

Getting Started with Mobile Cardiac Telemetry

Posted on: 08.13.14

Mobile Cardiac Telemetry (MCT) is a part of the emerging science of wireless monitoring in the health industry. Typically, MCT is used in the identification and treatment of heart conditions.

Telerhythmics, LLC, established in 1997, is a 24-hour cardiac event monitoring service provider used on an outsourced basis by hospitals and physician offices. Based in Memphis, Tennessee, Telerhythmics provides its monitoring services nationwide.

Their goal is to act as an extension of a doctor’s office or hospital system providing top-notch analysis of diagnostic data generated by a patient undergoing MCT monitoring, according to Telerhythmics Vice President and General Manager, Jason Callaway.

Determining the Need

Any patient reporting an abnormal heartbeat or chest pain to his/her physician is an ideal candidate for Ambulatory Cardiac monitoring. Indications for MCT monitoring include: asymptomatic arrhythmias, complete syncope, medication titration, post CABG and post ablation.

In the past, 24-hour monitoring was the industry standard, but with improvements to wireless MCT technology, it is now much easier to monitor patients over a longer period — anywhere from a few days to a month.

“Most arrhythmias that patients have, if they’re transient, don’t occur within a 24-hour or 48-hour period,” said Callaway.

A heart monitor paired with a Bluetooth-enabled mobile device is all it takes for Telerhythmics to gather and interpret patient data.

Setting Up

Once a doctor determines a patient would benefit from MCT, setting it up is easy. All relevant patient demographics and insurance information are collected when the heart monitoring device is applied to a patient by the doctor’s staff.

Baseline diagnostics are collected and sent to Telerhythmics to ensure everything is working properly, and then patients are free to go about their daily business until it is time to return to the doctor for their results. The length of monitoring is at the discretion of the doctor.

Monitoring the Patient

Diagnostic data is continuously recorded by the device. When an anomaly is detected, the device sends data from the preceding and following five minutes to the Telerhythmics monitoring center. The data is then interpreted by a qualified, cardiac-trained registered nurse.

Telerhythmics provides 24/7 monitoring and quickly notifies doctors when abnormal patient diagnostics are detected.

Reporting the Data

Through the duration of monitoring Telerhythmics compiles the data and interprets what is most relevant for the doctor to make a diagnosis.

A comprehensive report will show all detected anomalies as well as provide comparative diagnostics with patient data that is automatically collected and stored every ten minutes regardless of whether an anomaly is detected.

The doctor is then free to interpret the data and form a diagnosis as he or she sees fit.

Final Thoughts

Above all else, Telerhymics is committed to facilitating top-of-the-line service from doctors to patients. With experienced cardiac nurses providing around the clock monitoring, physicians and patients receive the highest level of customized patient care.

Digirad Diagnostic Services for Nuclear Cardiology

Posted on: 07.31.14

Recently, Digirad had the pleasure of interviewing Dr. Glenn Gandelman, a cardiologist with Greenwich Cardiology Associates in Connecticut. Greenwich Cardiology Associates uses Diagnostic Services from Digirad to perform nuclear cardiology imaging at their office. Digirad provides accredited technologists and technicians, and a multi-head mobile camera to perform the studies.

How often do you use Diagnostic Services from Digirad?

Greenwich Cardiology Associates has been using Digirad’s nuclear service regularly since 2008. The team visits every other week, and they typically scan between 8 and 14 patients per session.

How do you like working with Digirad?

Their efficiency is really impressive. The Digirad staff is very professional and great with throughput. They coordinate and prepare the tests, which allows me to continue seeing other patients.

We always receive good feedback from the patients and our staff regarding the Digirad team. There is a consistent group of 6 or 7 rotating techs, which allows the practice to really know the team.

What is the response to Digirad?

The local community knows that Greenwich Cardiology Associates offers outpatient imaging. Patients and referring doctors are delighted to know that imaging can be done outside the hospital because imaging in our office takes half the time it would at the hospital.

What are some of the benefits of using Digirad?

Without Digirad, there is no way we could offer this type of imaging in an outpatient setting. When making the decision at the time, we prepared a detailed pro-forma to look at the benefits of owning a camera versus using the diagnostic services from Digirad, and for our office, Digirad service made more financial sense.

Also, with Digirad, the patients and doctors can go over the results in our office. Overall, it is a faster and more pleasant experience for everyone involved.

Cesium Iodide: The Future of Solid State Imaging

Posted on: 07.24.14

What is Solid State?

Surprisingly, the majority of gamma cameras still used in nuclear medicine today utilize Anger-based technology; vacuum tubes and hygroscopic sodium iodide (NaI) crystals, technologies that are now more than 50 years old.

In response to the demands for better sensitivity and high energy resolution, a new generation of solid state pixelated cameras has been developed. Solid state imaging is classified by the absence of vacuum tubes, and replaces antiquated photomultiplier tubes (PMTs) with segmented crystals and semiconductors. The major advantage of these cameras is that they can determine locations with complete certainty. They accomplish this by pixelating the camera’s detector head into tiles instead of a continuous sheet of tubes.

There is a widespread misconception that only cadmium zinc telluride (CZT) is used in solid state nuclear imaging. In fact, there are actually two types of solid state nuclear imaging technology: direct conversion, which uses cadmium zinc telluride (CZT); and indirect conversion, which uses cesium iodide (CsI) with a photodiode.

Issues with CZT

There are claims that CZT is ten times more sensitive than NaI/PMT. However, in actual practice, a CZT camera’s photopeak detection efficiency is only 64% of either NaI/PMT or CsI/Photodiode. This poor intrinsic peak efficiency is due to a common problem in direct conversion solid state detectors called hole tailing. The resulting loss of sensitivity means that the energy window must be set wider than necessary for the specified energy resolution to recover the lost photopeak counts. Additionally, there is no improvement in scatter rejection with CZT, resulting in higher costs and reduced precision.

Next Generation of Solid State

Although Digirad’s first generation of solid state detectors used CZT, the material was abandoned in the late 1990s to pursue indirect conversion solid state detector heads using CsI with a photodiode. CsI is a scintillator which has good stopping power for low-energy gamma rays, emits more optical photons than sodium iodide, and has lower manufacturing costs. CsI also allows for the same gamma ray reaction as CZT, but the conversion is done indirectly using a photodiode.

Digirad’s solid state detectors, optimized with CsI and Digirad’s patented photodiode, offer the following benefits:

They produce high quality, solid state imaging.
They are much lighter and compact, providing the ability to create new gantry designs for rapid imaging.
They can acquire both SPECT and CT, requiring only one gantry.
CsI/photodiode is more affordable than CZT because it is less expensive to produce the material.

Using CsI coupled with Digirad’s patented photodiode, instead of CZT is beneficial to both the patient and your office because it allows you to provide superior imaging quality at a lower cost. Digirad’s CsI/photodiode technology is the newest generation of solid state nuclear imaging.

Trade-in and Upgrade your Equipment with Digirad’s Technology Refresh Program

Posted on: 07.17.14

Frequent advances in technology, regulatory changes, and reductions in reimbursements can diminish the efficiency and value of your nuclear imaging services. In today’s healthcare market, you need to provide the highest quality at the lowest cost to drive true value for your practice and the patients you serve. The way you have always done things is likely not the optimal way any more.

If you’re looking to get more value from your current equipment, Digirad’s Technology Refresh Program can help you reduce expenses and improve your equipment with no direct expense to your practice.

Here are a few things to consider…

What do you want to do with your nuclear imaging lab?
Still trying to image with a single head camera?
Do you have an older camera, but your volumes are much lower compared to when you first purchased it?
Do you need new technology but can’t rationalize a purchase given your current volumes?
Perhaps your camera is great but your operational costs are eating away at profits. Would you like Digirad to repair and maintain your equipment?
Do you want to keep your current camera but want help to maximize your efficiency and profitability?

Digirad’s efficiency experts can help you maximize your financial returns based on your current clinical needs.

Upgrade Options

Digirad can assist you with trading in and upgrading your equipment. If you are looking to buy a new camera, Digirad can buy your old equipment and deduct the value of your equipment from the cost of your new purchase.

If you are looking to upgrade your nuclear imaging without having to purchase a new camera, consider Diagnostic Services from Digirad. Digirad provides your choices of licensing, physics consulting, accreditation, staff, equipment, and cloud-based PAC systems for your nuclear lab. Digirad will determine the value of your existing equipment, and then work with you to reflect that value in your Diagnostic Services contract. We can customize a program to your specifications while maximizing your outcomes and your profitability.

Large practice or small; independent or integrated; outreach clinic or main facility; our portfolio of solutions could benefit everyone.

Determining the Value of Existing Equipment

Digirad offers a number of options for upgrading your current equipment. The value of your existing equipment depends on a number of factors, including:

How old is the camera?
Is it a single or multi-head SPECT camera?
What type of software does it have?
Is it under a service contract?

All of these factors influence the value of your equipment. Digirad will assess its value and provide you with options for upgrading.

Upgrade Benefits

With an upgrade, you can have the most advanced, up-to-date technology at a reduced cost to your practice. Here are some of the benefits of upgrading your old equipment through Digirad’s Technology Refresh Program:

Move to solid state technology
Get up to a triple-head camera
Scan faster with better quality images
Attenuation correction with the Cardius® X-ACT
Meet accreditation standards
Reduce dosage and radiation exposure to patients
Eliminate costly overhead expenses
Scale your equipment to meet current patient demand

Upgrading your equipment will make your practice more efficient and cost-effective, and you will be able to offer your patients access to the latest technology.

Hassle-Free Radiation Safety and Licensing with Digirad

Posted on: 07.10.14

Do you know what it takes to establish a nuclear lab in your office? If you are considering purchasing a nuclear gamma camera or offering nuclear imaging services in your office, be aware that there is a lot more to the process than just researching and buying a new camera. You must ensure that you meet all of the regulatory and safety requirements.

Nuclear Imaging Requirements

There are a number of requirements for offering nuclear imaging services. It takes a lot of time, a substantial financial investment, and the continual management of a radiation safety program. First, you must obtain a radioactive materials license (RML). Licensing is gained through the Nuclear Regulatory Commission (NRC) or the applicable state agency. Generally, you must hire a physicist to assist with the application process. There is a licensing fee and ongoing cost for quarterly audits by a physicist. Once you obtain a license, you are held responsible by the agency that issued the license. You must establish a Radiation Safety Committee, holding ongoing meetings and manage all documentation for safety audits as well as NRC or State Inspections. RML holders are responsible for meeting the safety standards of the applicable regulations. Violations can result in citations as well as potentially substantial fines.

Digirad Imaging Services

If you choose to use Diagnostic Services from Digirad, you don’t have to worry about any licensing or safety concerns. Digirad takes care of everything. As part of our Nuclear Cardiology service for both mobile sites and fixed camera sites, we obtain the license and provide the following:

All RM licensing needs including application, renewal and inspections
Physicist support including audits and ongoing support requirements
Radiation Safety Committee and all related requirements
Exit surveys and wipe tests on each day of service
Qualified nuclear medicine technologists who are certified by NMTCB or ARRT(N)

Digirad operates under ALARA (As Low As Reasonably Acceptable) principles. This means that we make every reasonable effort to ensure that radiation exposure is kept as low as possible. Our ALARA program includes radiation safety, operating, and emergency procedures.

Digirad is ultimately responsible for the radiation safety program and all aspects of the license. The license will be listed at your office address, but it will be in Digirad’s name. The state holds Digirad responsible for safety and maintenance.

Whether you own a camera, use our fixed site services solution, or utilize our mobile, in-facility imaging service, choosing Digirad ensures that you experience no hassles and minimal costs for licensing, physics consulting, and accreditation.

Customer Profile: Diagnostic Cardiology Group

Posted on: 06.24.14

Digirad recently had the pleasure of interviewing Dr. Selcuk A. Tombul and Patti Dennis of the Diagnostic Cardiology Group in Chattanooga, Tennessee. The Diagnostic Cardiology Group has been a Digirad customer since 2008, and they use our nuclear and ultrasound services two to three days per week to complement their full-time service. Dr. Tombul and Ms. Dennis spoke to us about their experiences with Digirad and discussed some of the ways that Digirad has accommodated their needs.

The Diagnostic Cardiology Group was founded in 2004 by four partners, but they’ve since expanded to include six full-time physicians who provide a wide variety of diagnostic and therapeutic services. Presently, the practice is a multi-specialty group with three areas of focus: interventional cardiology, electrophysiology, and invasive and nuclear cardiology.

The Shift to Nuclear Cardiology

Around 2008, the partners decided to pursue nuclear cardiology but were concerned about the required expenses and regulations. Not only were there costs associated with dedicated nuclear equipment, but there were also radiation requirements that would involve significant staff training and credentials. This was difficult to accommodate due to frequent fluctuations in their appointment volume.

They went with Digirad due to the flexibility, quality, and value of the services provided. Essentially, Digirad’s onsite service allows them to gain the financial benefit of in-office nuclear diagnostic testing without the cost of equipment ownership, and headache of maintaining it. They never have to spend money on equipment or staff they are not using, and they can adjust the number of days the service is used according to their appointment demands.

Digirad Benefits

The Diagnostic Cardiology Group identified a number of benefits to using Digirad’s services. Dr. Tombul appreciates the quality of Digirad’s equipment and reports. Digirad provides the practice with access to state-of-the-art equipment, and all he has to do is provide a patient exam space. And with the web-based PAC system, a report can be generated rapidly in one setting, saving time, administrative space, and personnel.

Ms. Dennis explained that from a patient’s perspective, Digirad’s onsite services are more convenient and less costly. Patients don’t have to travel to a different location, and they also appreciate the professionalism and promptness of Digirad’s staff when they are onsite. And because the practice receives the reimbursement for using the service, there is a better value all around. Thanks to Digirad, the Diagnostic Cardiology Group can keep their overhead in check and still provide their patients with outstanding value and service.

The Digirad Outsourcing Strategy

Posted on: 06.17.14

In early 2013, we made the decision to outsource production of our Digirad Ergo, X-ACT, and Cardius® XPO Series camera modules and gantries. We chose to partner with a local manufacturing company, Spectrum Assembly Inc. (SAI), known for its cutting-edge technology and equipment. This contract manufacturing arrangement allowed us to take advantage of highly specialized technology with both scalability and consistency of quality.

Why Outsource?

Digirad’s manufacturing partnership with SAI facilitates more efficient use of labor, faster turnaround times, and access to newer, state-of-the art equipment. SAI’s flexible, automated approach yields products with a consistent quality on par with the high standards we’ve set with our products over the years, which is vital to maintaining our clinical and electronic edge. Contrary to popular assumptions, outsourcing is actually a consistent driver in the quality of our camera modules.

Additionally, adopting a build-to-order system enables us, over time, to reduce our standing inventory and improve the availability of assets as we shifted to manufacturing on an as-needed basis.

In-House Quality Control and Reviews

Although it made sense to transfer production of camera modules and gantries to SAI, we chose to keep two of our key manufacturing processes in house: Head Integration & Testing and Final System Assembly & Testing. This selective focus grew out of our desire to apply our technical expertise and resources to those processes we do best. By having the final assembly and testing of detector heads and imaging systems done at our Poway facility we can verify, test and ensure that each new camera meets our high quality standards.

Looking Ahead

Contract manufacturing is a key component of our strategic plan to update and enhance our current products. As we find more effective ways to allocate our resources, Digirad is better positioned to take advantage of new opportunities for growth and expansion. Our partnership with SAI allows us to meet market demands while producing advanced solid-state nuclear imaging cameras of the highest quality.

The Sustainable Growth Rate Formula – What Does It Mean For You?

Posted on: 06.10.14

What is SGR?

The sustainable growth rate (SGR) is a method used to control spending by Medicare on physician services. Based on the previous year’s total and target expenditures, SGR links physician payments to changes in gross domestic product (GDP). The idea behind the sustainable growth rate model is to prevent Medicare spending per beneficiary from growing faster than the US economy.

The current Medicare model uses a fee schedule to determine physician payments. Physicians are paid according to the complexity of the services being provided and economic factors such as GDP. The fee that a physician receives is based on three variables: the relative value for the service, a geographic pricing cost index (GPCI), and a national dollar conversion factor.

How SGR Works

SGR influences the fee schedule in the following manner. Every year, the Centers for Medicare and Medicaid Services (CMS) determines the previous year’s costs, as well as a conversion factor that changes physician payments for the following year. If actual expenditures exceed the target, the corresponding fee schedule update is reduced, triggering a cut in physician payments. If the actual expenditures are less than the target, however, the fee schedule and payments are increased. Changes take place on the first of March every year.

History of SGR

Since 1992, Medicare has reimbursed physicians on a fee-for-service basis. In 1997 Congress was concerned that Medicare spending was increasing too quickly and threatening the program’s sustainability. At the time, growth rates in the volume and complexity of physician services were low, and forecasters expected these slow growth rates to prevail. Consequently, they introduced the SGR formula as part of the Balanced Budget Act of 1997.

At first the SGR formula kept pace with changes to physicians’ costs, generating a few modest pay increases for physicians. Within several years, however, the growth rate reversed and expenditures increased rapidly, resulting in cuts to physician payment rates. In every year since 2002, Congress has responded to the impending cuts with a “doc fix,” or short-term patch that simply delays the cuts.

SGR in 2014

In January 2014, in response to a looming 24 percent pay cut for physicians, Congress announced a plan to propose a long-term solution to the SGR formula by April 1, 2014. However, no final agreement or solution was ever reached. Instead, on April 1, 2014, President Obama signed H.R. 4302, the Protecting Access to Medicare Act of 2014. H.R. 4302 implemented a twelve-month patch averting the 24 percent cut and replacing it with a 0.5 percent update lasting until April 1, 2015. It also stipulated a zero percent update for the first quarter of 2015.

Digirad’s Ergo: Improving Pediatric Diagnostic Imaging

Posted on: 06.04.14

Scientific posters are one of the highlights at the SNMMI Annual Meeting, where thousands of medical professionals gather to explore the newest developments in nuclear imaging. This year, Digirad’s Ergo™ Imaging System is featured on a poster created by Michael Czachowski, Marcy Stoecklein, Scott Connors, Jennifer Conver, Thomas Harding, and Ashok Muthukrishnan, M.D. of Children’s Hospital of Pittsburgh (CHP) of UPMC, a long-time Digirad customer.

The abstract poster, titled “Merits of a solid-state portable camera in a pediatric imaging environment,” explains why CHP chose the Ergo, and the tremendous benefits it has offered to the hospital.

Digirad recently spoke with Michael Czachowski about the way CHP has used its Ergo camera. CHP’s Ergo was purchased nearly four years ago and has been used in a variety of applications throughout the hospital. Czachowski spoke highly of the Ergo’s convenient portability, explaining that it is often taken directly into the CICU or operating room, both of which have very limited space. CHP also brings the Ergo into patient units when the patient’s condition is too critical to permit movement. He went further to explain the cost savings and the staff’s appreciation of Ergo’s portability by eliminating the need for nurses, and in some cases physicians and respiratory technicians, to wait in the nuclear medicine department during the entire scan process. Czachowski also praised the Ergo’s reliability, noting that it has been used daily for nearly four years with only two days of downtime.

If you’d like to learn more about CHP’s experience with Digirad’s Ergo, we encourage you to stop by the SNMMI Exhibit Hall to view the poster. Visit Hall 5 to see the full poster published under Abstract No. 2653, and meet the authors Monday, June 9 between 3:00pm and 4:30pm. Click here to read the abstract online.

Visit Digirad’s Booth 1503 at the SNMMI 2014 Annual Meeting to see the Ergo on exhibit and learn how it can benefit your healthcare system.

May News Digest

Posted on: 05.27.14

The imaging industry (and healthcare in general) is continually evolving. It adjusts to changes in standards, advancements in technology, facilities’ requirements, and healthcare regulations. It’s important to stay informed about the changes in healthcare that may impact the development, operation, maintenance, and growth of your imaging services. Here is a look at some recent news articles.

Trend Toward Quality and Value

The healthcare industry is responding to economic changes primarily with cost-cutting tactics. However, in order to stay competitive, hospitals need to do more than cut costs; they need to re-engineer the way they work. The emphasis is on quality and value, and this is being realized by CMS implementing the physician value-based payment modifier (VBM). Continue Reading >

MedAxiom Cardiology Video Library

MedAxiom recently launched Heart to Heart, the first public searchable educational video library for cardiology. The videos feature administrative and physician leaders in cardiology, and topics range from leveraging integration to operations and performance management. The library currently contains over 100 videos and can be accessed from MedAxiom’s website. Continue Reading >

Is Accreditation Worth the Money?

During the ACC CV Summit in January, attendees discussed the benefits and value of accreditation. Examples included an increase in referrals, higher reimbursements from Medicare, and increased quality. Continue Reading >

New Blood Pressure Guidelines

New guidelines published in February changed the blood pressure goals in adults over age 60 from 140/90 to 150/90. This change reduces the proportion of adults eligible for high blood pressure medication from 41 percent to 32 percent. Continue Reading >

Updated Recommendations on Cardiac Imaging Radiation Exposure

New recommendations on radiation exposure from cardiac imaging procedures call for more disclosure between providers and patients about the benefits and risks. Continue Reading >

AMIC’s Rebuttal to Overutilization of Imaging Claim

A recent article published by Third Way, a political think tank, claimed that imaging is overused, which puts patients in danger and wastes money. The Access to Medical Imaging Coalition (AMIC) published a rebuttal, stating that Third Way’s claim was based on fragmented, inaccurate data. Continue Reading >

Understanding Peripheral Neuropathy Disease

Posted on: 05.20.14

Autonomic neuropathy disorders affect involuntary body functions that include heart rate, blood pressure, perspiration, and digestion. Damage to the autonomic nerves disrupts signals between the brain and the effected portions of the autonomic nervous system, like the heart, blood vessels, and sweat glands. Peripheral neuropathy (PN) is a type of autonomic neuropathy that specifically affects the extremities and causes decreased or abnormal performance to occur within one or more bodily functions. Signs, symptoms, and treatments of PN vary depending on the cause, and on which nerves were affected.

Symptoms

PN symptoms can cause numbness or reduced sensory abilities. Signs and symptoms of peripheral neuropathy include:

A tingling or burning feeling
Pain when walking
Sharp, jabbing pain that may be worse at night
Extreme sensitivity to the lightest touch—for example, extreme pain under the weight of a sheet
Muscle weakness, fatigue, or atrophy
Serious foot problems like ulcers, infections, deformities, and bone and joint pain

Causes

PN can arise from a complication related to a number of diseases and conditions. Potential causes may also include poisoning, exposure to toxins, chemotherapy, or physical injuries. Some medications can even cause neuropathy as a side effect.

While the most common worldwide cause of PN is leprosy, in the United States it is diabetes. For some people, diabetic neuropathy can be mild, while for others it can be very painful and, in worst cases, fatal.

Patients with Syndrome X, a compromised immune system, Parkinson’s disease, Lyme disease, HIV/AIDS, hereditary disorders, B12 deficiency and botulism, or any other chronic medical condition are also at high risk for PN and should be checked regularly for nerve damage.

Diagnosis

PN is diagnosed through a combination of techniques including medical history, physical examinations, imaging tests, and nerve function tests. A nerve conduction study works by monitoring the peripheral nervous system and evaluating its response to stimuli. The test can be completed quickly and is pain free.

Treatments

Consistently keeping blood sugar within a safe range can help delay the progression of PN and may even bring about improvement with symptoms.

Early detection of PN can also help bring about aggressive intervention within its early stages. Treatments for PN should focus on attaining any or all of the following results: remission, slowing progression of the disease, pain relief, monitored and ongoing evaluation, and managing complications and restoring functions. To help slow damage, the following is advised:

Good foot care
Practice blood pressure control
Implement a healthy eating plan
Stop smoking
Maintain weight
Perform physical activity
Avoid alcohol

Medications

While there are several medications used to relieve nerve pain, some come with worse side effects and may not work for everyone. However, some common and effective pain relieving treatments include:

Anti-seizure medications
Antidepressants
Lidocaine patch
Opioids

There are also a number of alternative therapies for pain relief, such as use of capsaicin cream or acupuncture. Consult your doctor for the best treatment method specific for you.

Digirad Expands Service Contract Options to Support Philips, GE, Siemens, and More

Posted on: 05.13.14

Do you like the idea of a one-stop option for all your medical equipment service needs? Well, so do we! For your convenience, Digirad provides service options to support various cameras from multiple vendors. Our Camera Support team consists of highly skilled service engineers with an average of 15 years of experience on all major vendors’ SPECT equipment. If you are in need of immediate phone support, expedited parts delivery, or an expert service engineer to be onsite quickly, Digirad is your solution.

Which Nuclear Medicine SPECT cameras do we service?

Digirad has service agreement options to support all major Single Photon Emission Computed Tomography (SPECT) cameras including, but not limited to:

Philips

CardioMD
Genesys (single or dual head)
Vertex

Millennium MyoSight
Millennium MG
Millennium MPS
Millennium MPR
Ventri

Siemens

C-CAM
E-CAM

Sopha Medical Vision – SMV DST-Xli

IS2 – Pulse

Segami – MaiCam

What types of agreement options are available?

Digirad offers a variety of service plans to meet your needs:

The Full-Service Agreement gives you complete comprehensive coverage for your equipment.
The Limited Service Agreement provides an economical solution with essential service coverage.
The Preventative Maintenance solution offers minimal service solutions from a trusted service provider and unlimited technical phone support.

What kind of service will you be receiving?

Our goal of providing high quality exceptional service as needed, when needed, and where needed is the foundation of our Camera Support business. Our dedicated team of experienced service engineers is positioned nationwide to use critical diagnostic skills to quickly and accurately resolve any request without compromise to value and service.

How can I get started?

A Digirad Camera Support team member can assist you in assessing your service needs and guide you to the option best suited to protect your medical asset. Whichever plan you choose, we are committed to supporting you with exceptional service and quality at economical pricing. Request an estimate today!

SNMMI Annual Meeting

Posted on: 05.06.14

Visit us at Booth 1503!

digirad-snmmi-annual-meeting Every summer the Society of Nuclear Medicine and Molecular Imaging (SNMMI) hosts its Annual Meeting, a five-day conference for medical professionals, scientists, and technologists involved in nuclear medicine and molecular imaging.

This year the SNMMI Annual Meeting will take place in St. Louis, MO, from June 7-11, 2014. Featuring a variety of specialty workshops, seminars, and exhibitions, the conference is recognized as the premier event for networking and continuing education in molecular imaging and nuclear medicine.

This year’s exhibit floor promises to be a highlight of the conference as it showcases a wealth of exhibitors known for driving the latest changes and advances in the industry. Check out the latest developments in emerging technology, and take advantage of valuable face-time with nearly 200 distinguished exhibitors.

Digirad is proud to be exhibiting its nuclear gamma cameras at the 2014 SNMMI Annual Meeting. You can find us at Booth 1503. Click here to view the exihbit map.

We hope you’ll stop by and see us!

Digirad Acquires Telerhythmics

Posted on: 03.28.14

Outsourced Cardiac Monitoring Service for Physicians and Hospitals

Digirad Corporation announced today that it has acquired all the outstanding membership interest of Telerhythmics, LLC, a 24-hour cardiac event monitoring service used on an outsourced basis by hospitals and physician offices. Based in Memphis, Tennessee, privately-held Telerhythmics provides its monitoring services throughout the eastern region of the U.S.

Total up front consideration for the purchase was approximately $3.6 million, which included a $3.47 million cash payment up front and assumption of approximately $131,000 in debt. In addition, there is an earn-out opportunity of up to $501,000 over approximately three years based on meeting certain EBITDA targets. Telerhythmics will continue to operate from its current facility in Memphis. Further information is contained in a Form 8-K filed today with the U.S. Securities and Exchange Commission.

Digirad President and CEO Matthew G. Molchan commented, “Telerhythmics, like Digirad’s DIS operations, is a platform business that can support additional services, and cardiac event monitoring is an important outsourced service. Telerhythmics is also a solid, entrenched enterprise with nearly 20 years in the business and has a high quality reputation in the industry.”

Telerhythmics generated approximately $5.6 million in revenue in 2013. Once Telerhythmics goes through a short integration period, it is expected to be accretive on an EBITDA basis. Under Digirad’s ownership and at the 2013 level of annual revenue, it is expected the business will generate approximately $350,000 of EBITDA in the first twelve months, and then approximately $800,000 of EBITDA annually thereafter.

Molchan continued, “The addition of Telerhythmics fits squarely in our business model and our mission to provide medical services and technology on an as needed, where needed and when needed basis. Its target market is virtually the same as our target market with DIS, and acquiring Telerhythmics allows us to drive additional services via our existing channels and expand and diversify our business operations, allowing us more opportunities to grow and broaden our geographic reach.”

Digirad signs agreement with Spectrum Assembly

Posted on: 10.11.13

Digirad Corporation, the leader in solid-state diagnostic imaging technology and services, announced today that it has signed an exclusive agreement with Spectrum Assembly, Inc. to outsource the manufacturing of its advanced, solid-state nuclear imaging cameras.

Digirad President and CEO Matthew G. Molchan said, “This agreement is exactly in line with our continued strategy to focus on driving income, cash flow and growth from our businesses at Digirad. As we have stated previously, we continue to believe our nuclear imaging cameras, with their solid-state design and technology, are well suited to meet the needs of the health-care industry, both domestically and internationally. With this new agreement, our camera production will become more cost effective, nimble and flexible to meet the demands of our customers and the market. Further, with this move to outsource manufacturing of our cameras, as well as our recent announcement to partner with Dilon Diagnostics to distribute our cameras internationally, we believe we are well-positioned to take advantage of these domestic and international opportunities in a very cost effective manner.”

Digirad featured on MedAxiom

Posted on: 09.20.13

Digirad CEO Matt Molchan was recently featured in an interview with MedAxiom. You can read the article on MexAxiom here or read the interview below.

Q: Why have you chosen MedAxiom as a strategic partner?
A: As a healthcare products and services innovator, Digirad has successfully worked with some of the leading Practices and Healthcare Systems in Cardiology. How healthcare will be delivered and our role within the healthcare delivery system makes MedAxiom an ideal strategic partner for our company. Like MedAxiom, we work with practice executives, administrative leaders, physicians and offices with a goal of improving clinical and business outcomes for our clients. We believe that our products and services are an ideal match for the MedAxiom membership. As both a traditional equipment manufacturer and a healthcare services company, we hope to bring value to MedAxiom as a Partner that thinks like a member.

Q: How does your business currently interact with the Cardiology environment?
A: Digirad is the largest company of it’s kind. We offer a wide range of services and products for the diagnosis of cardiovascular disease. Through these services and products, we currently assist more than 1200 clients in the Cardiology environment with the care of their patients. These clients are comprised of independent practices, integrated practices, Hospitals and Healthcare Systems.

Q: What services are utilized by practices, hospitals, physicians?
A: In our Diagnostic Services division, Digirad offers a vast array of ‘As Needed, Where Needed, When Needed’ solutions to assist practices, hospitals and healthcare systems to provide high quality, accredited imaging services. Our current service offerings include the outsourcing of fixed site and mobile, in facility nuclear cardiology services, echocardiography and vascular ultrasound services, neuropathy services and molecular profile services. We also offer short and long term technologist staffing, licensing, accreditation and precertification services or consultation. The fastest growing segment of our business is working hand in hand with Cardiology Service Line Executives to rebalance their imaging programs, to maximize or to create a true outreach program for their integrated practice as well as with their integrated primary care practices.

From short term staffing to fully outsourced Hospital Nuclear Medicine Departments; from in-office complete imaging services to Healthcare System Outreach programs .. and everywhere in between…we match the exact amount of services supply with your demand.

Q: What products are utilized by practices, hospitals, physicians?
A: In our Diagnostic Imaging Product division, Digirad’s portfolio is based on our now 4th generation solid-state detector technology for myocardial perfusion imaging. The Cardius Series includes a triple headed system for stationary use (installed in a single location) and a dual headed system that can be configured as a stationary (installed in a single location) or mobile (able to be easily moved between locations). The Premier Product in the Cardius Series is the X-ACT. The X-ACT system features rapid imaging detector geometry, a fluorescence X-ray attenuation correction approach along with a unique 3D-OSEM reconstruction algorithm creating the optimal low dose imaging system. The X-ACT meets today and tomorrow’s challenges for reducing doses, rapid imaging, improved patient satisfaction and improved outcomes while raising clinical performance for nuclear cardiology. Also, Digirad’s Customer Service department offers an assortment of relationships to provide ‘Best In Class’ repair and maintenance services.

Q: What is unique about Digirad’s Nuclear Cardiology cameras?
A: In addition to Digirad’s proprietary 4th Generation Solid-State Detectors, all of our systems are configured with ‘Tru-Acq’ and ‘nSPEED.’ Tru-Acq allows a technologist, without regard to injected dose, to know the imaging time required on a per patient, at the time of imaging basis. nSPEED is a market proven, iterative reconstruction algorithm that maximizes image quality based on count density. This combination of ‘Personalized Imaging’ tools gives our clients clinical and technical capabilities to meet the demands of rapid imaging and to meet the expectations of the 2014 ASNC dose reduction initiative. The X-ACT system combines these features with a low dose, Volume CT attenuation correction approach that simply sets a new, higher standard for SPECT imaging.

Q: What differentiates your organization from others?
A: Digirad is unique in the diagnostic imaging space as we are the only company that truly offers scalable solutions. By way of the services we provide and the cameras that we manufacture, Digirad matches the customers demand with the exact amount of supply. Our approach to the market, allows our representatives the opportunity to offer prospective clients solutions matched to their true needs. Almost any scenario involving diagnostic imaging and cardiology is possible with Digirad. Whether you want to buy, lease or rent equipment, staffing, licensing, accreditation or customer service, we can help you. If you want to enroll as an imaging services customer, we can do that as a fixed site, five days a week solution or support you with a mobile, in office solution on a weekly, bi-weekly, or monthly basis. We’ll take on all the hassles like licensing, physics consultation, accreditation, precertification, reporting, cloud based imaging and report management to seamlessly support your organization. You could also own the equipment and have us operate the department. We offer an endless amount of solutions to meet our customers’ needs.

MedAxiom members would likely be pleasantly surprised by the possibilities!

Q: How do you intend to add more value to your customers in the next 12 months?
A: In our Diagnostic Services division, we will continue to expand the number of and types of services offered to ideally meet the market needs as the healthcare environment continues to evolve. We will roll out models that are both clinically and financially efficient for independent practice, integrated practices, Hospitals and Healthcare Systems. Digirad is committed to providing scalable solutions that provide the best care for your patients and the most cost efficient, convenient services for our clients.

In our Diagnostic Imaging Products division, we will build on our legacy as a technology innovator by continuing to enhance our ‘Personalized Imaging’ platform. Given the pressures of patient satisfaction, image quality, and new dose reduction expectations, we will continue to add new tools to the ‘Personalized Imaging’ toolbox. These new tools will be available on new systems and as upgrades to existing systems.

We will also add more value to the Cardiology market overall by aggressively offering Technology Refresh programs focused on practices, Hospitals and Healthcare systems with aging equipment in need of today’s technology improvements.

Q: What new services can we expect to see released in the next 12 months?
A: Digirad anticipates adding several new services to our portfolio in the next 6 to 24 months. These services will be cardiology focused and available to existing as well as new clients. The key is that we will offer these services with our philosophy of matching our supply with your demand. This ‘As Needed, Where Needed, When Needed’ mentality will play a key role in helping our clients navigate their business in the new healthcare environment. We will also be more active with our Technology Refresh program for owners of older cameras that want to migrate to today’s imaging standards either through our services or products.

Q: What are your long-term goals in serving the cardiology market?
A: At Digirad, our long-term goal is to be the Cardiology market’s “First Thought” when faced with a challenge or opportunity. Many of our current customers tell us “whenever something new or difficult comes up – the first thing I think of is Digirad.” That’s awesome because that means we are doing our job of providing products and services that improves their delivery of healthcare. Interestingly, we hear these types of comments as much from our large clients and Healthcare Systems as from our small clients. We understand the challenges of today’s healthcare for private practices, integrated practices, Hospitals and Healthcare Systems. We know, through our services and products, that we can help all of them. That’s why our goal is to be the Cardiology market’s “First Thought” when faced with a challenge or opportunity.

Q: What aspects of your products and services are most appealing to both the physicians and administrators?
A: It’s the scalability, flexibility, convenience and breadth of our offerings. We balance clinical quality, practice convenience, and patient retention with the real need for financial benefit.

Q: Who should the MedAxiom members contact with questions about your company or products?
A: MedAxiom members should feel free to contact Matt Molchan, CEO and President of Digirad, Virgil Lott, President of Digirad Diagnostic Imaging, or Marty Shirley, SVP of Digirad Diagnostic Services Sales & Marketing. We are all happy to help MedAxiom members in any way possible.

DIS at 2013 ASNC Conference

Posted on: 08.15.13

Digirad Imaging Solutions (DIS) will be exhibiting at the 18th annual Scientific Session of the American Society of Nuclear Cardiology Conference. The conference will be held at the Hyatt Regency Chicago, IL on September 26 – 29. If you are attending the show, stop by booth #323 and say hello.

Digirad Announces Sale of Surgical Imaging Technology

Posted on: 08.12.13

Digirad Announces Sale of Surgical Imaging Technology Assets to Novadaq Technologies. Agreement Calls for $2 Million of Up Front Consideration, Deferred Contingent Payments, Royalties

Digirad Corporation announced today that it has signed an agreement to sell its “Trapper” Surgical Imaging Technology previously under development, as well as license “Trapper” related technology to Novadaq Technologies, a publicly-traded developer of clinically-relevant imaging solutions for use in surgical and outpatient wound care procedures. Under the terms of the agreement, Digirad will receive up front consideration of $2 million and up to $1 million in deferred contingent payments based on the achievement of specific regulatory and commercial milestones. In addition, a royalty on sales will be paid for a period of five years from the date of the first commercial sale.

“The creation of the Trapper system and technology evolved from a number of research and development initiatives, and given our recent strategic shift toward cash generation, as well as creating and returning shareholder value, we decided to monetize these non-core assets,” said Digirad President and CEO Matthew G. Molchan. “Of course, we are very pleased that Novadaq, which is a leader in the surgical imaging industry and well suited to take this technology to market, recognized the value of the technology we developed. The transaction provides Digirad additional capital, giving the Company more options going forward and helps assure that valuable, clinical technology can reach patients faster.”

About Digirad Corporation Digirad is one of the largest national providers of in-office nuclear cardiology imaging and ultrasound services to physician practices, hospitals and imaging centers, and also sells medical diagnostic imaging systems for nuclear cardiology and general nuclear medicine applications. For more information, please visit www.digirad.com. Digirad(R) and Cardius(R) are registered trademarks of Digirad Corporation.

Forward-Looking Statements This press release contains statements that are forward-looking statements as defined within the Private Securities Litigation Reform Act of 1995. These include statements regarding the Company’s ability to deliver value to customers, the Company’s ability to grow and generate positive cash flow, the ability to execute on restructuring activities, and ability to successfully execute acquisitions. These forward-looking statements are subject to risks and uncertainties that could cause actual results to differ materially from the statements made, including the risks associated with changes in business conditions, technology, customers’ business conditions, reimbursement, radiopharmaceutical shortages, economic outlook, operational policy or structure, acceptance and use of Digirad’s camera systems and services, reliability, recalls, analysis of potential impairment and restructuring charges, the conclusion of our audit and other risks detailed in Digirad’s filings with the U.S. Securities and Exchange Commission, including the Annual Report on Form 10-K, Quarterly Reports on Form 10-Q, Current Reports on Form 8-K and other reports. Readers are cautioned to not place undue reliance on these forward-looking statements, which speak only as of the date hereof. All forward-looking statements are qualified in their entirety by this cautionary statement, and Digirad undertakes no obligation to revise or update the forward-looking statements contained herein.

Digirad CEO Matt Molchan featured on The Street

Posted on: 08.08.13

With Digirad stock up 20% this year, “The Street” in New York recently requested an interview with CEO Matt Molchan to discuss Digirad and its new strategic plan. Click here to view Matt’s interview on The Street >

DIS Adds Neuropathy Testing Program

Posted on: 07.12.13

DIS is happy to announce that we are now offering a comprehensive Neuropathy Testing Program. As with the nuclear and ultrasound programs, the service is provided at your office and can scale to meet your needs.

The program consists of nerve conduction tests and uses a Sudo Scan machine to perform the screening. DIS has a team of highly qualified Neurologists who oversee the program. When creating the program, DIS was seeking to create three outcomes. First was to create a neurological baseline for the patient, then to assess damage to the patient’s neurological system and finally to better manage patient care and compliance.

Neuropathy testing is a growing field for physicians as approximately 1 out of every 15 (20 million) people suffer from neuropathy and more than 30% of all neuropathies stem from Diabetes.

Results are provided through the DIS Cardiostream system and are typically delivered within 24-48 hours. The Cardiostream system permanently stores the records, giving you unlimited access.

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